Robert Alan Wightman
Individual provider Active NPI General Practice Dentistry · Cook, MN
NPI 1952769697 · NPPES record last updated Jul 22, 2017
Key facts
- NPI
- 1952769697
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D13787 (MN)
- Practice address
- 20 5TH St SE
Cook, MN 55723-9702 - Phone
- (218) 666-5958
- NPI assigned
- Feb 9, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D13787 | MN | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D13787 | MN | Yes |
Addresses
Primary practice location
20 5TH St SE
Cook, MN 55723-9702
Mailing address
20 5TH St SE
Cook, MN 55723
Phone (218) 666-5958
Other providers in Cook, MN
- Michael Morris Talberg
- True Care Medical Therapy Center Inc
- Turning Point Counseling PA
- Fred Lawrence Webber
- Kiara Westendorf
- Emily Kate Wild
- Celin R Williams
All providers in Cook, MN · General Practice Dentistry in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.