Provider Demographics
NPI:1609478585
Name:ROBINSON, TARA (RDH)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 S LAKE DR APT 4
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:WI
Mailing Address - Zip Code:53235-5256
Mailing Address - Country:US
Mailing Address - Phone:407-375-3003
Mailing Address - Fax:
Practice Address - Street 1:4060 S LAKE DR APT 4
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:WI
Practice Address - Zip Code:53235-5256
Practice Address - Country:US
Practice Address - Phone:407-375-3003
Practice Address - Fax:800-863-5373
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21470124Q00000X
IL020016866124Q00000X
WI100366116124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist