Provider Demographics
NPI:1861424590
Name:DIRECTOR, ROBERT CORBIN
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CORBIN
Last Name:DIRECTOR
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 1:1110 N BANCROFT PKWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2669
Mailing Address - Country:US
Mailing Address - Phone:302-658-7358
Mailing Address - Fax:302-655-5328
Practice Address - Street 1:1110 N BANCROFT PKWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2669
Practice Address - Country:US
Practice Address - Phone:302-658-7358
Practice Address - Fax:302-655-5328
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00008601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000892708Medicaid