Provider Demographics
NPI:1134383078
Name:REMMICK, ROBERT ALAN (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:REMMICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-0673
Mailing Address - Country:US
Mailing Address - Phone:701-662-8980
Mailing Address - Fax:701-662-8504
Practice Address - Street 1:310 4TH ST NW
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301
Practice Address - Country:US
Practice Address - Phone:701-662-8980
Practice Address - Fax:701-662-8504
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1134383078OtherND BCBS
MN1134383078OtherMN BCBS
ND41467Medicaid
ND949424OtherND DENTAL SERVICE CORP