Provider Demographics
NPI:1639181373
Name:RAMIREZ, ROBERT JR (DDS, MS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RAMIREZ
Suffix:JR
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11671 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4139
Mailing Address - Country:US
Mailing Address - Phone:512-335-8600
Mailing Address - Fax:512-996-8118
Practice Address - Street 1:11671 JOLLYVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4139
Practice Address - Country:US
Practice Address - Phone:512-335-8600
Practice Address - Fax:512-996-8118
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168691223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD16869OtherBLUE CROSS BLUE SHIELD