Provider Demographics
NPI:1619255247
Name:HARRIS, ROBERT DOVER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DOVER
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111A S TIMBERWAY
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815-9739
Mailing Address - Country:US
Mailing Address - Phone:540-901-2151
Mailing Address - Fax:
Practice Address - Street 1:111A S TIMBERWAY
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815-9739
Practice Address - Country:US
Practice Address - Phone:540-901-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014132221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice