Provider Demographics
NPI:1851436471
Name:ROBINSON, DAN RAY (DMD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:RAY
Last Name:ROBINSON
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 1:675 RODEO DR
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-3714
Mailing Address - Country:US
Mailing Address - Phone:435-725-3368
Mailing Address - Fax:435-725-3370
Practice Address - Street 1:675 RODEO DR
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-3714
Practice Address - Country:US
Practice Address - Phone:435-725-3368
Practice Address - Fax:435-725-3370
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6890810-9923122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist