Provider Demographics
NPI:1801816046
Name:PANKRATZ, ROBERT S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:PANKRATZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 PENROSE PL STE 107
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1809
Mailing Address - Country:US
Mailing Address - Phone:303-443-8250
Mailing Address - Fax:303-443-7397
Practice Address - Street 1:3400 PENROSE PL STE 107
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1809
Practice Address - Country:US
Practice Address - Phone:303-443-8250
Practice Address - Fax:303-443-7397
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO91391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry