Provider Demographics
NPI:1457361149
Name:FLINT, ROBERT D (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:FLINT
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 1:2684 WHITE HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:WV
Mailing Address - Zip Code:26554
Mailing Address - Country:US
Mailing Address - Phone:304-363-1655
Mailing Address - Fax:304-363-9093
Practice Address - Street 1:2684 WHITE HALL BLVD
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-363-1655
Practice Address - Fax:304-363-9093
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134017000Medicaid