Provider Demographics
NPI:1578586160
Name:ROBINSON, ROBERT W III (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:ROBINSON
Suffix:III
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 1:935 WESTPOINT DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7143
Mailing Address - Country:US
Mailing Address - Phone:907-376-3884
Mailing Address - Fax:907-373-7500
Practice Address - Street 1:935 WESTPOINT DR
Practice Address - Street 2:SUITE 201
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7143
Practice Address - Country:US
Practice Address - Phone:907-376-3884
Practice Address - Fax:907-373-7500
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD2628Medicaid
AK5657OtherBUSINESS LICENSE