Provider Demographics
NPI:1861381113
Name:ROBLES, MARIO HENRIQUE (DMD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:HENRIQUE
Last Name:ROBLES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 RAVEN TRL APT 10127
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-2187
Mailing Address - Country:US
Mailing Address - Phone:786-319-8476
Mailing Address - Fax:
Practice Address - Street 1:12509 SOUTH FWY
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7113
Practice Address - Country:US
Practice Address - Phone:817-258-5509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist