Provider Demographics
NPI:1245455039
Name:TEMPLE, ROBERT EDMOND (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDMOND
Last Name:TEMPLE
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 1:514 ROE ST
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-2820
Mailing Address - Country:US
Mailing Address - Phone:253-588-2566
Mailing Address - Fax:253-588-2566
Practice Address - Street 1:1101 YAKIMA AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4831
Practice Address - Country:US
Practice Address - Phone:253-680-7311
Practice Address - Fax:253-680-7211
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000089051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice