1184870065 NPI number — MS. ROBIN ELIZABETH BAGBY D.D.S.

Table of content: MS. ROBIN ELIZABETH BAGBY D.D.S. (NPI 1184870065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184870065 NPI number — MS. ROBIN ELIZABETH BAGBY D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAGBY
Provider First Name:
ROBIN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HINRICHS
Provider Other First Name:
ROBIN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1184870065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4102 ELECTRIC RD.
Provider Second Line Business Mailing Address:
BLUE RIDGE ENDODONTICS
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-772-9515
Provider Business Mailing Address Fax Number:
540-772-0716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4102 ELECTRIC RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24018-0614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-772-9515
Provider Business Practice Location Address Fax Number:
540-772-0716
Provider Enumeration Date:
08/12/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  0401008987 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)