Provider Demographics
NPI:1518025949
Name:AUDET, ROBERT HENRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HENRY
Last Name:AUDET
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 APPLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1223
Mailing Address - Country:US
Mailing Address - Phone:508-347-3017
Mailing Address - Fax:508-347-7088
Practice Address - Street 1:22 MAIN ST
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1246
Practice Address - Country:US
Practice Address - Phone:508-347-7171
Practice Address - Fax:508-347-7088
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAXO8491OtherBLUE CROSS BLUE SHIELD