Provider Demographics
NPI:1871579789
Name:VICEK, ROBYN ELAINE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:ELAINE
Last Name:VICEK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2865
Mailing Address - Country:US
Mailing Address - Phone:419-447-9242
Mailing Address - Fax:419-447-5437
Practice Address - Street 1:205 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2865
Practice Address - Country:US
Practice Address - Phone:419-447-9242
Practice Address - Fax:419-447-5437
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH206971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics