Provider Demographics
NPI:1134172968
Name:HERRIN, ROBERT ALEXANDER (DDS MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALEXANDER
Last Name:HERRIN
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 SPRINGBANK LN.
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226
Mailing Address - Country:US
Mailing Address - Phone:704-541-3603
Mailing Address - Fax:704-541-3619
Practice Address - Street 1:3111 SPRINGBANK LN.
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:704-541-3603
Practice Address - Fax:704-541-3619
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37931223S0112X
NC245951223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993844Medicaid
1519273OtherCIGNA
19579OtherWELLPATH
0581487OtherAETNA
560953592OtherTAX ID
01083OtherBCBS
1221384OtherUNITED HEALTHCARE
T83780Medicare UPIN