Provider Demographics
NPI:1205157294
Name:ROBERT E PIERCE, DMD, PC
Entity type:Organization
Organization Name:ROBERT E PIERCE, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-502-0011
Mailing Address - Street 1:1450 OLD CHEMSTRAND RD #448
Mailing Address - Street 2:
Mailing Address - City:GONZALEZ
Mailing Address - State:FL
Mailing Address - Zip Code:32560-7806
Mailing Address - Country:US
Mailing Address - Phone:850-502-6488
Mailing Address - Fax:850-462-2430
Practice Address - Street 1:DOCTOR'S MEMORIAL HOSPITAL
Practice Address - Street 2:2600 HOSPITAL DR DEPT OF SURGERY
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-4264
Practice Address - Country:US
Practice Address - Phone:850-502-0011
Practice Address - Fax:251-217-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118421200Medicaid
FL076590200Medicaid