Provider Demographics
NPI:1013111277
Name:ROBERT L. HAMBLIN, D.D.S.
Entity Type:Organization
Organization Name:ROBERT L. HAMBLIN, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-377-7200
Mailing Address - Street 1:3200 N CANYON RD STE F
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4571
Mailing Address - Country:US
Mailing Address - Phone:801-377-7200
Mailing Address - Fax:
Practice Address - Street 1:3200 N CANYON RD STE F
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4571
Practice Address - Country:US
Practice Address - Phone:801-377-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1416491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT563949673010Medicaid
UT670212OtherUNITED CONCORDIA ID