Provider Demographics
NPI:1699839050
Name:SHOREY, ROBERT DOUGLAS (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:SHOREY
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 1:1420 E ROSEVILLE PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3081
Mailing Address - Country:US
Mailing Address - Phone:916-791-2907
Mailing Address - Fax:916-791-4990
Practice Address - Street 1:1420 E ROSEVILLE PKWY STE 210
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3081
Practice Address - Country:US
Practice Address - Phone:916-791-2907
Practice Address - Fax:916-791-4990
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31387122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist