Provider Demographics
NPI:1538201751
Name:HARRIS, ROBERT B JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:HARRIS
Suffix:JR
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 1:111 CEDAR LAKES DR
Mailing Address - Street 2:PO BOX 526
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-1607
Mailing Address - Country:US
Mailing Address - Phone:304-372-9281
Mailing Address - Fax:307-372-8453
Practice Address - Street 1:111 CEDAR LAKES DR
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1607
Practice Address - Country:US
Practice Address - Phone:304-372-9281
Practice Address - Fax:307-372-8453
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV01325256000Medicare ID - Type UnspecifiedGENERAL DENTISTRY