Provider Demographics
NPI:1609183979
Name:FIFE, ROBERT NATHAN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NATHAN
Last Name:FIFE
Suffix:JR
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 1:1783 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-5562
Mailing Address - Country:US
Mailing Address - Phone:334-361-9959
Mailing Address - Fax:334-361-9188
Practice Address - Street 1:1783 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-5562
Practice Address - Country:US
Practice Address - Phone:334-361-9959
Practice Address - Fax:334-361-9188
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice