Provider Demographics
NPI:1790987089
Name:ROBINSON, MICHAEL DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:165 MAIN ST
Mailing Address - Street 2:OPEN DOOR FAMILY MEDICAL CENTER
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4702
Mailing Address - Country:US
Mailing Address - Phone:914-941-1263
Mailing Address - Fax:914-762-7224
Practice Address - Street 1:5 GRACE CHURCH ST
Practice Address - Street 2:OPEN DOOR FAMILY MEDICAL CENTERS, INC.
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4911
Practice Address - Country:US
Practice Address - Phone:914-937-7817
Practice Address - Fax:914-937-7732
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY033391122300000X
NJ11879NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473029Medicaid