Provider Demographics
NPI:1720265697
Name:JUSTICE, ROBERT VOLNEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VOLNEY
Last Name:JUSTICE
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:PO BOX 397
Mailing Address - Street 2:AVENAL STATE PRISON #1 KINGS WAY
Mailing Address - City:AVENAL
Mailing Address - State:CA
Mailing Address - Zip Code:93204
Mailing Address - Country:US
Mailing Address - Phone:559-386-0587
Mailing Address - Fax:559-386-7449
Practice Address - Street 1:#1 KINGS WAY
Practice Address - Street 2:ASP
Practice Address - City:AVENAL
Practice Address - State:CA
Practice Address - Zip Code:93204
Practice Address - Country:US
Practice Address - Phone:559-386-0587
Practice Address - Fax:559-386-7449
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist