Provider Demographics
NPI:1548383953
Name:BAXTER, ROBERT MITCHELL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MITCHELL
Last Name:BAXTER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4713 GREENWAY CT
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7855
Mailing Address - Country:US
Mailing Address - Phone:817-485-0533
Mailing Address - Fax:817-838-9444
Practice Address - Street 1:3992 DENTON HWY
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76117-2509
Practice Address - Country:US
Practice Address - Phone:817-838-2344
Practice Address - Fax:817-838-9444
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice