Provider Demographics
NPI:1598146904
Name:WINGO, ROBERT DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DANIEL
Last Name:WINGO
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:PO BOX 759
Mailing Address - Street 2:3533 UNION HILL ROAD
Mailing Address - City:JOELTON
Mailing Address - State:TN
Mailing Address - Zip Code:37080-0759
Mailing Address - Country:US
Mailing Address - Phone:615-876-4262
Mailing Address - Fax:615-876-2325
Practice Address - Street 1:3353 UNION HILL RD
Practice Address - Street 2:
Practice Address - City:JOELTON
Practice Address - State:TN
Practice Address - Zip Code:37080-8726
Practice Address - Country:US
Practice Address - Phone:615-876-4262
Practice Address - Fax:615-876-2325
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN100771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice