Provider Demographics
NPI:1669595955
Name:ROBINSON, STEPHEN WILLIAM SR (DDS,MSD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:ROBINSON
Suffix:SR
Gender:M
Credentials:DDS,MSD
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Mailing Address - Street 1:3475 PLYMOUTH BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1499
Mailing Address - Country:US
Mailing Address - Phone:763-546-6700
Mailing Address - Fax:763-546-6702
Practice Address - Street 1:3475 PLYMOUTH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1499
Practice Address - Country:US
Practice Address - Phone:763-546-6700
Practice Address - Fax:763-546-6702
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MND74631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics