Provider Demographics
NPI:1053472563
Name:VARN, ROBERT A (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:VARN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4834
Mailing Address - Country:US
Mailing Address - Phone:803-536-6440
Mailing Address - Fax:803-268-9921
Practice Address - Street 1:695 LAUREL ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4834
Practice Address - Country:US
Practice Address - Phone:803-536-6440
Practice Address - Fax:803-268-9921
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ18366Medicaid