Provider Demographics
NPI:1447273172
Name:HART, ROBERT SAMUEL II (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SAMUEL
Last Name:HART
Suffix:II
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 1:16921 CRAWLEY RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2048
Mailing Address - Country:US
Mailing Address - Phone:813-382-3650
Mailing Address - Fax:
Practice Address - Street 1:4710 N HABANA AVE STE 203
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7146
Practice Address - Country:US
Practice Address - Phone:813-879-8097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN41091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice