Provider Demographics
NPI:1447460043
Name:ROBINETTE, SAMUEL PRESTON (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:PRESTON
Last Name:ROBINETTE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1269
Mailing Address - Street 2:
Mailing Address - City:SOUTH SHORE
Mailing Address - State:KY
Mailing Address - Zip Code:41175-1269
Mailing Address - Country:US
Mailing Address - Phone:606-932-4050
Mailing Address - Fax:606-932-4050
Practice Address - Street 1:472 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOUTH SHORE
Practice Address - State:KY
Practice Address - Zip Code:41175-1269
Practice Address - Country:US
Practice Address - Phone:606-932-4050
Practice Address - Fax:606-932-4050
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60051521Medicaid