Individual
DR. STACY ELMO ROBINSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
925 W 6TH S, MTN HOME, ID 83647-3300
(208) 587-2222
(208) 587-9100
Mailing address
925 W 6TH S, MTN HOME, ID 83647-3300
(208) 587-2222
(208) 587-9100
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3517
ID
Other
Enumeration date
04/04/2007
Last updated
07/08/2007
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