Provider Demographics
NPI:1205081486
Name:HUMBLE, ROBERT LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LYNN
Last Name:HUMBLE
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 1:22840 NE 8TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7262
Mailing Address - Country:US
Mailing Address - Phone:425-898-0400
Mailing Address - Fax:425-898-1705
Practice Address - Street 1:22840 NE 8TH ST
Practice Address - Street 2:STE 101
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7262
Practice Address - Country:US
Practice Address - Phone:425-898-0400
Practice Address - Fax:425-898-1705
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA74291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice