Provider Demographics
NPI:1518097427
Name:THOUSAND, ROBERT R III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:THOUSAND
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ST. JOHNS MEDICAL PARK DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-797-3044
Mailing Address - Fax:904-797-3045
Practice Address - Street 1:10 SAINT JOHNS MEDICAL PK DR
Practice Address - Street 2:STE. C
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5201
Practice Address - Country:US
Practice Address - Phone:904-797-3044
Practice Address - Fax:904-797-3045
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 146711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics