Provider Demographics
NPI:1154496834
Name:DRS POORE ROBINSON & ASSOCIATES PA
Entity Type:Organization
Organization Name:DRS POORE ROBINSON & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JEFFERSON
Authorized Official - Last Name:POORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-663-1354
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-0669
Mailing Address - Country:US
Mailing Address - Phone:704-663-1354
Mailing Address - Fax:704-662-3213
Practice Address - Street 1:672 CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2538
Practice Address - Country:US
Practice Address - Phone:704-663-1354
Practice Address - Fax:704-662-3213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
058688359OtherADA
058688359OtherADA
BR6430413OtherDEA