Provider Demographics
NPI:1487746236
Name:PRESTON, ROBERT DENNIS JR
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DENNIS
Last Name:PRESTON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 SAVITZ DR
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-2729
Mailing Address - Country:US
Mailing Address - Phone:858-472-6169
Mailing Address - Fax:
Practice Address - Street 1:BRACH MEDICAL CLINIC
Practice Address - Street 2:NAVAL SUPPORT ACTIVITY MID-SOUTH
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38054
Practice Address - Country:US
Practice Address - Phone:901-874-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman