Individual
DR. ROBERT J PROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS PA
Contact information
Practice address
605 VANTAGE DRIVE, STEPHENVILLE, TX 76401
(254) 965-2541
(254) 965-4531
Mailing address
605 VANTAGE DRIVE, STEPHENVILLE, TX 76401
(254) 965-2541
(254) 965-4531
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D11524
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
759508
UNITED CONCORDIA PROVIDER
TX
Enumeration date
08/21/2006
Last updated
07/08/2007
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