Provider Demographics
NPI:1174782320
Name:ROBINSON, PATRICK GORDON (DMD)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:GORDON
Last Name:ROBINSON
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 1:855 SUNSET DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7718
Mailing Address - Country:US
Mailing Address - Phone:706-549-1370
Mailing Address - Fax:
Practice Address - Street 1:855 SUNSET DR
Practice Address - Street 2:SUITE 10
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7718
Practice Address - Country:US
Practice Address - Phone:706-549-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0137191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice