Provider Demographics
NPI:1891828380
Name:STUDEBAKER, ROBERT V (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:V
Last Name:STUDEBAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 S AMERICANA BLVD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6733
Mailing Address - Country:US
Mailing Address - Phone:208-345-8962
Mailing Address - Fax:208-345-5207
Practice Address - Street 1:782 S AMERICANA BLVD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6733
Practice Address - Country:US
Practice Address - Phone:208-345-8962
Practice Address - Fax:208-345-5207
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-38991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice