Provider Demographics
NPI:1902061807
Name:ALBISTON, ROBERT STANLEY (DDS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STANLEY
Last Name:ALBISTON
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 1:208 MOUNTAIN MEADOW DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84029-9315
Mailing Address - Country:US
Mailing Address - Phone:405-227-5505
Mailing Address - Fax:405-789-3239
Practice Address - Street 1:14 N. HALE STREET
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84029-9315
Practice Address - Country:US
Practice Address - Phone:435-884-3476
Practice Address - Fax:435-884-6790
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60581223G0001X
UT7330714-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice