Provider Demographics
NPI:1871032425
Name:IMPLANT & GENERAL DENTISTRY CORP
Entity Type:Organization
Organization Name:IMPLANT & GENERAL DENTISTRY CORP
Other - Org Name:ROBERT L. REBERT, JR. DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:REBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-885-7510
Mailing Address - Street 1:5037 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:3D
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5136
Mailing Address - Country:US
Mailing Address - Phone:504-885-7510
Mailing Address - Fax:
Practice Address - Street 1:5037 VETERANS MEMORIAL BLVD
Practice Address - Street 2:3D
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5136
Practice Address - Country:US
Practice Address - Phone:504-885-7510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty