Provider Demographics
NPI:1578779740
Name:HACKER, ROBERT M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:HACKER
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 1:134 MONTOWESE ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3841
Mailing Address - Country:US
Mailing Address - Phone:203-488-7444
Mailing Address - Fax:203-483-8539
Practice Address - Street 1:134 MONTOWESE ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3841
Practice Address - Country:US
Practice Address - Phone:203-488-7444
Practice Address - Fax:203-483-8539
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0076291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice