Provider Demographics
NPI:1578551677
Name:ERNST, ROBERT A (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:ERNST
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 1:217 LAMPLIGHTER LN
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-5237
Mailing Address - Country:US
Mailing Address - Phone:860-667-8223
Mailing Address - Fax:860-665-8179
Practice Address - Street 1:365 WILLARD AVE
Practice Address - Street 2:SUITE 2H
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2373
Practice Address - Country:US
Practice Address - Phone:860-667-8277
Practice Address - Fax:860-667-4911
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0043171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics