Provider Demographics
NPI:1972889210
Name:GORTON, ROBBYN NICHOLE (RDH)
Entity Type:Individual
Prefix:MISS
First Name:ROBBYN
Middle Name:NICHOLE
Last Name:GORTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 E 18TH WAY
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-8528
Mailing Address - Country:US
Mailing Address - Phone:970-319-0856
Mailing Address - Fax:
Practice Address - Street 1:195 W 14TH
Practice Address - Street 2:BLDG C
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-4700
Practice Address - Country:US
Practice Address - Phone:970-945-2840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905847124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist