Provider Demographics
NPI:1639511611
Name:ROBERT W EISBERG II DDS PA
Entity Type:Organization
Organization Name:ROBERT W EISBERG II DDS PA
Other - Org Name:ATLANTIC FAMILY DENTAL, RALEIGH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:EISBERG
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-368-6439
Mailing Address - Street 1:106 CEDAR CLIFF CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8209
Mailing Address - Country:US
Mailing Address - Phone:919-368-6439
Mailing Address - Fax:
Practice Address - Street 1:3944 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1700
Practice Address - Country:US
Practice Address - Phone:919-368-6439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC82671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty