Provider Demographics
NPI:1437353711
Name:HARRELL, ROBERT L
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:HARRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 BALLANTYNE COMMONS PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2889
Mailing Address - Country:US
Mailing Address - Phone:704-541-9888
Mailing Address - Fax:704-541-7944
Practice Address - Street 1:7820 BALLANTYNE COMMONS PKWY STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2889
Practice Address - Country:US
Practice Address - Phone:704-541-9888
Practice Address - Fax:704-541-7944
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist