Provider Demographics
NPI:1801915756
Name:TREMBLAY, ROBERT LEO (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEO
Last Name:TREMBLAY
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 1:26711 WOODWARD AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1367
Mailing Address - Country:US
Mailing Address - Phone:248-543-3834
Mailing Address - Fax:248-543-5535
Practice Address - Street 1:26711 WOODWARD AVE STE 105
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1367
Practice Address - Country:US
Practice Address - Phone:248-543-3834
Practice Address - Fax:248-543-5535
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI114581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice