Provider Demographics
NPI:1255433256
Name:ROBBEN, LARRY WAYNE (DDS)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:WAYNE
Last Name:ROBBEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:L
Other - Middle Name:WAYNE
Other - Last Name:ROBBEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:18 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931
Mailing Address - Country:US
Mailing Address - Phone:321-783-0868
Mailing Address - Fax:
Practice Address - Street 1:3000 N ATLANTIC AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931
Practice Address - Country:US
Practice Address - Phone:321-784-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist