Provider Demographics
NPI:1356878409
Name:STRATMAN, ROBERT BROCK (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BROCK
Last Name:STRATMAN
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 1:435 VIRGINIA AVE UNIT 102
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-1965
Mailing Address - Country:US
Mailing Address - Phone:317-498-0420
Mailing Address - Fax:
Practice Address - Street 1:8060 N SHADELAND AVE STE B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2690
Practice Address - Country:US
Practice Address - Phone:317-288-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012683A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice