Provider Demographics
NPI:1679986020
Name:GAGNON, ROBYN LEIGH (DMD)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:LEIGH
Last Name:GAGNON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5658 FISHHAWK CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-5900
Mailing Address - Country:US
Mailing Address - Phone:561-271-3338
Mailing Address - Fax:
Practice Address - Street 1:14410 CARIBBEAN BREEZE DR
Practice Address - Street 2:#102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-5473
Practice Address - Country:US
Practice Address - Phone:561-271-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist