Provider Demographics
NPI:1457349664
Name:ROBY, TODD MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MICHAEL
Last Name:ROBY
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 1:1055 17TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2680
Mailing Address - Country:US
Mailing Address - Phone:303-776-2020
Mailing Address - Fax:303-776-2091
Practice Address - Street 1:1055 17TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2680
Practice Address - Country:US
Practice Address - Phone:303-776-2020
Practice Address - Fax:303-776-2091
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45475512Medicaid