Provider Demographics
NPI:1316003882
Name:ERDMAN, ROBERT (DDS PA)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:ERDMAN
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:ERDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PA
Mailing Address - Street 1:2578 S VOLUSIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-9124
Mailing Address - Country:US
Mailing Address - Phone:386-775-1552
Mailing Address - Fax:386-775-1312
Practice Address - Street 1:2578 S VOLUSIA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-9124
Practice Address - Country:US
Practice Address - Phone:386-775-1552
Practice Address - Fax:386-775-1312
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist