Provider Demographics
NPI:1821762063
Name:HABIB, ROBINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBINA
Middle Name:
Last Name:HABIB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4249
Mailing Address - Country:US
Mailing Address - Phone:706-944-3122
Mailing Address - Fax:
Practice Address - Street 1:17 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4249
Practice Address - Country:US
Practice Address - Phone:706-944-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN116531223G0001X
GADN122332122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice