Provider Demographics
NPI:1760675433
Name:LINK, ROBERT WALL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WALL
Last Name:LINK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1419
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92531-1419
Mailing Address - Country:US
Mailing Address - Phone:951-579-4450
Mailing Address - Fax:888-505-0677
Practice Address - Street 1:29280 CENTRAL AVE
Practice Address - Street 2:UNIT F
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-2219
Practice Address - Country:US
Practice Address - Phone:951-579-4450
Practice Address - Fax:888-505-0677
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA242351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice