Provider Demographics
NPI:1629214986
Name:CONNER, ROBYN (RDA)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 E EL PASO AVE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2427
Mailing Address - Country:US
Mailing Address - Phone:559-432-2226
Mailing Address - Fax:
Practice Address - Street 1:200 W SHAW AVE STE 110
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3684
Practice Address - Country:US
Practice Address - Phone:559-325-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33550126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant