Provider Demographics
NPI:1740229061
Name:EMBLOM, ROBERT G (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:EMBLOM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 HEALTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1907
Mailing Address - Country:US
Mailing Address - Phone:334-678-1727
Mailing Address - Fax:334-678-1521
Practice Address - Street 1:318 HEALTHWEST DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1907
Practice Address - Country:US
Practice Address - Phone:334-678-1727
Practice Address - Fax:334-678-1521
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice