Provider Demographics
NPI:1538275581
Name:DERR, ROBERT E (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:DERR
Suffix:
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 1:7825 TERREY PINE CT
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1126
Mailing Address - Country:US
Mailing Address - Phone:952-934-3569
Mailing Address - Fax:952-934-3586
Practice Address - Street 1:7825 TERREY PINE CT
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-1126
Practice Address - Country:US
Practice Address - Phone:952-934-3569
Practice Address - Fax:952-934-3586
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice