Provider Demographics
NPI:1851428296
Name:PIERCE, ROBERT EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 OLD CHEMSTRAND RD UNIT 448
Mailing Address - Street 2:
Mailing Address - City:GONZALEZ
Mailing Address - State:FL
Mailing Address - Zip Code:32560-7818
Mailing Address - Country:US
Mailing Address - Phone:850-502-6488
Mailing Address - Fax:850-462-2430
Practice Address - Street 1:2600 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-4264
Practice Address - Country:US
Practice Address - Phone:850-502-6488
Practice Address - Fax:850-462-2430
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL3619122300000X
FLDN174491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076590200Medicaid