Provider Demographics
NPI:1689692097
Name:NOTARI, ROBERT JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:NOTARI
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 1:429 S MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1684
Mailing Address - Country:US
Mailing Address - Phone:570-451-0130
Mailing Address - Fax:570-451-0135
Practice Address - Street 1:429 S MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1684
Practice Address - Country:US
Practice Address - Phone:570-451-0130
Practice Address - Fax:570-451-0135
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-030981-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice