Provider Demographics
NPI:1669964854
Name:ROBBINS, PHILLIP MARTIN (DMD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:MARTIN
Last Name:ROBBINS
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 1:835 SW 75TH WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-4921
Mailing Address - Country:US
Mailing Address - Phone:850-287-3151
Mailing Address - Fax:
Practice Address - Street 1:6200 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3801
Practice Address - Country:US
Practice Address - Phone:386-325-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN233631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice