Provider Demographics
NPI:1871667063
Name:AUBUCHON, ROBERT WAYNE (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:AUBUCHON
Suffix:
Gender:M
Credentials:DDS, MSD
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Mailing Address - Street 1:2801 WATERMAN BLVD.
Mailing Address - Street 2:SUITE 190
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534
Mailing Address - Country:US
Mailing Address - Phone:707-429-5450
Mailing Address - Fax:707-429-7109
Practice Address - Street 1:3320 WEBSTER STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-452-4466
Practice Address - Fax:510-444-4272
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA221281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93911OtherDENTICAL