Provider Demographics
NPI:1861584252
Name:FROME, ROBERT KEITH (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KEITH
Last Name:FROME
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 1:1759 NW KINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1905
Mailing Address - Country:US
Mailing Address - Phone:541-753-3114
Mailing Address - Fax:541-753-4092
Practice Address - Street 1:1759 NW KINGS BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1905
Practice Address - Country:US
Practice Address - Phone:541-753-3114
Practice Address - Fax:541-753-4092
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice