Provider Demographics
NPI:1245451483
Name:ROBB, JOSEPH WALLACE III (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WALLACE
Last Name:ROBB
Suffix:III
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 1:56 PENNY LANE SUITE A
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-6018
Mailing Address - Country:US
Mailing Address - Phone:831-722-1318
Mailing Address - Fax:831-768-8117
Practice Address - Street 1:56 PENNY LANE SUITE A
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-6018
Practice Address - Country:US
Practice Address - Phone:831-722-1318
Practice Address - Fax:831-768-8117
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA265171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice