Provider Demographics
NPI:1639231863
Name:VANVALKENBURG, ROBERT FRANCIS (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRANCIS
Last Name:VANVALKENBURG
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 1:529 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108
Mailing Address - Country:US
Mailing Address - Phone:413-736-1635
Mailing Address - Fax:
Practice Address - Street 1:529 WHITE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108
Practice Address - Country:US
Practice Address - Phone:413-736-1635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA9736122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist