Provider Demographics
NPI:1447458039
Name:MEMSIC, ROBERT G JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:MEMSIC
Suffix:JR
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 1:2315 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2615
Mailing Address - Country:US
Mailing Address - Phone:310-546-3683
Mailing Address - Fax:
Practice Address - Street 1:3407 W 6TH ST
Practice Address - Street 2:SUITE 514
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2537
Practice Address - Country:US
Practice Address - Phone:310-546-3683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA232171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics