Provider Demographics
NPI:1255462859
Name:ROBINSON, GARY J (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:ROBINSON
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 1:121 W SOPHIA ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2164
Mailing Address - Country:US
Mailing Address - Phone:419-893-4541
Mailing Address - Fax:419-893-7199
Practice Address - Street 1:121 W SOPHIA ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-2164
Practice Address - Country:US
Practice Address - Phone:419-893-4541
Practice Address - Fax:419-893-7199
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14325OH1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0280548Medicaid
OH0280548Medicaid