Provider Demographics
NPI:1972501526
Name:KROODSMA, ROBERT M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:KROODSMA
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 1:13465 SW NAHCOTTA DR
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5784
Mailing Address - Country:US
Mailing Address - Phone:503-590-8441
Mailing Address - Fax:503-590-8415
Practice Address - Street 1:339 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4001
Practice Address - Country:US
Practice Address - Phone:503-640-3800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR48431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice