Provider Demographics
NPI:1639477417
Name:ROBINS, RADLEY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:RADLEY
Middle Name:B
Last Name:ROBINS
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 1:1362 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304
Mailing Address - Country:US
Mailing Address - Phone:936-539-2211
Mailing Address - Fax:936-539-2216
Practice Address - Street 1:1362 WILSON RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-539-2211
Practice Address - Fax:936-539-2216
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8023152-99211223G0001X
390200000X
TX308471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program