Provider Demographics
NPI:1841302452
Name:PLAMBECK, ROBERT D (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:PLAMBECK
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 1:2700 BAKER ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MUSKEGON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:49444-2157
Mailing Address - Country:US
Mailing Address - Phone:231-737-8603
Mailing Address - Fax:231-737-9012
Practice Address - Street 1:2700 BAKER ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MUSKEGON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:49444-2157
Practice Address - Country:US
Practice Address - Phone:231-737-8603
Practice Address - Fax:231-737-9012
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI143161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI88144OtherDELTA
MI00D8002810OtherBCBS
MI4129245Medicaid
MI383014011OtherTAX ID NUMBER