Provider Demographics
NPI:1851656284
Name:ROBERT A. MOULTHROP, DDS
Entity Type:Organization
Organization Name:ROBERT A. MOULTHROP, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFC MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANI
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MOULTHROP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-778-3384
Mailing Address - Street 1:18181 BUTTERFIELD BLVD
Mailing Address - Street 2:STE 160
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-8108
Mailing Address - Country:US
Mailing Address - Phone:408-778-3384
Mailing Address - Fax:408-779-1384
Practice Address - Street 1:18181 BUTTERFIELD BLVD
Practice Address - Street 2:STE 160
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-8108
Practice Address - Country:US
Practice Address - Phone:408-778-3384
Practice Address - Fax:408-779-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty