Provider Demographics
NPI:1902956915
Name:ROBINSON, RAND M R (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAND
Middle Name:M R
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 1:1225 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4630
Mailing Address - Country:US
Mailing Address - Phone:734-485-2082
Mailing Address - Fax:
Practice Address - Street 1:26650 EUREKA RD
Practice Address - Street 2:SUITE B
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4835
Practice Address - Country:US
Practice Address - Phone:734-955-8908
Practice Address - Fax:734-955-3910
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4045109Medicaid