Provider Demographics
NPI:1295997914
Name:SHUB, ROBERT E (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:SHUB
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 1:3003 VAN NESS ST NW
Mailing Address - Street 2:S-212
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008
Mailing Address - Country:US
Mailing Address - Phone:202-537-1124
Mailing Address - Fax:202-244-5184
Practice Address - Street 1:3003 VAN NESS ST NW
Practice Address - Street 2:S-212
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008
Practice Address - Country:US
Practice Address - Phone:202-537-1124
Practice Address - Fax:202-244-5184
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist