Provider Demographics
NPI:1841414935
Name:BRAND D ROBINSON DDS, PC
Entity Type:Organization
Organization Name:BRAND D ROBINSON DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAND
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-587-7411
Mailing Address - Street 1:4265 FALLON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6797
Mailing Address - Country:US
Mailing Address - Phone:406-587-7411
Mailing Address - Fax:406-587-2357
Practice Address - Street 1:4265 FALLON ST STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6797
Practice Address - Country:US
Practice Address - Phone:406-587-7411
Practice Address - Fax:406-587-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT17191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT130052Medicaid