Provider Demographics
NPI:1811055759
Name:RELLE, ROBERT JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:RELLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:SUITE #610
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-842-4811
Mailing Address - Fax:310-861-0178
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE #610
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-842-4811
Practice Address - Fax:310-861-0178
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA342031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery