Provider Demographics
NPI:1295110377
Name:ROBISON, SARA (DMD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ROBISON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CANNON PKWY
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3620
Mailing Address - Country:US
Mailing Address - Phone:817-430-1212
Mailing Address - Fax:817-491-0154
Practice Address - Street 1:1405 CANNON PKWY
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-3620
Practice Address - Country:US
Practice Address - Phone:817-430-1212
Practice Address - Fax:817-491-0154
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist