Provider Demographics
NPI:1780805671
Name:DIDIER, ROBERT P (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:DIDIER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1130 MONTICELLO RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2031
Mailing Address - Country:US
Mailing Address - Phone:707-265-6892
Mailing Address - Fax:707-253-3988
Practice Address - Street 1:2305 MENDOCINO AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3157
Practice Address - Country:US
Practice Address - Phone:707-525-1501
Practice Address - Fax:707-525-0315
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220651223G0001X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered174400000XOther Service ProvidersSpecialist