Provider Demographics
NPI:1518122852
Name:LOTHROP, ROBERT FRANKLIN (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRANKLIN
Last Name:LOTHROP
Suffix:
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 1:112 S VINE ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-1751
Mailing Address - Country:US
Mailing Address - Phone:712-527-4854
Mailing Address - Fax:
Practice Address - Street 1:112 S VINE ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1751
Practice Address - Country:US
Practice Address - Phone:712-527-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA064931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01656539Medicaid