Provider Demographics
NPI:1972679470
Name:PROTZMAN, ROBERT A
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:PROTZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 ASH PARK DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-3280
Mailing Address - Country:US
Mailing Address - Phone:573-584-6770
Mailing Address - Fax:
Practice Address - Street 1:757 W STADIUM BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-4786
Practice Address - Country:US
Practice Address - Phone:573-584-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice