Provider Demographics
NPI:1144367186
Name:STROUD, ROBERT CASEY
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CASEY
Last Name:STROUD
Suffix:
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 1:134 EL CHICO TRL STE 101
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-8862
Mailing Address - Country:US
Mailing Address - Phone:817-441-2425
Mailing Address - Fax:817-441-2491
Practice Address - Street 1:134 EL CHICO TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-8861
Practice Address - Country:US
Practice Address - Phone:817-441-2425
Practice Address - Fax:817-441-2491
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry