Provider Demographics
NPI:1013085240
Name:DZIEJMA, ROBERT P (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:DZIEJMA
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 1:7105 BAKERS BRIDGE AVE, #400
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-376-0011
Mailing Address - Fax:615-376-0593
Practice Address - Street 1:7105 BAKERS BRIDGE AVE, #400
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-376-0011
Practice Address - Fax:615-376-0593
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28601223P0700X
TN86591223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics