Provider Demographics
NPI:1578661971
Name:LEPARD, ROBERT L (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:LEPARD
Suffix:
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 1:121 W AVENUE B
Mailing Address - Street 2:
Mailing Address - City:MULESHOE
Mailing Address - State:TX
Mailing Address - Zip Code:79347-3611
Mailing Address - Country:US
Mailing Address - Phone:806-272-3446
Mailing Address - Fax:806-272-4921
Practice Address - Street 1:121 W AVENUE B
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-3611
Practice Address - Country:US
Practice Address - Phone:806-272-3446
Practice Address - Fax:806-272-4921
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0904062-02Medicaid
TXB1421001OtherCHIPS PROVIDER ID
TXB1421001OtherCHIPS PROVIDER ID