Provider Demographics
NPI:1710549456
Name:ROBINSON DENTAL LLC
Entity Type:Organization
Organization Name:ROBINSON DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVELL
Authorized Official - Middle Name:PORTER
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-954-6000
Mailing Address - Street 1:3706 E FLORENCE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6048
Mailing Address - Country:US
Mailing Address - Phone:208-954-6000
Mailing Address - Fax:
Practice Address - Street 1:4274 N EAGLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0726
Practice Address - Country:US
Practice Address - Phone:209-994-5922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental