Provider Demographics
NPI:1407062896
Name:ROBERT, DUANE EVERETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:EVERETT
Last Name:ROBERT
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 1:618 E CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-1559
Mailing Address - Country:US
Mailing Address - Phone:912-449-4102
Mailing Address - Fax:912-449-0549
Practice Address - Street 1:618 E CARTER AVE
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-1559
Practice Address - Country:US
Practice Address - Phone:912-449-4102
Practice Address - Fax:912-449-0549
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0093741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice