Provider Demographics
NPI:1770733610
Name:REBECCA L ROBBINS DDS LLC
Entity type:Organization
Organization Name:REBECCA L ROBBINS DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-442-5437
Mailing Address - Street 1:1220 SOM CENTER ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-442-5437
Mailing Address - Fax:440-442-5438
Practice Address - Street 1:1220 SOM CENTER ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-442-5437
Practice Address - Fax:440-442-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.215701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2774510Medicaid