Provider Demographics
NPI:1699808675
Name:EARNEY, ROBERT JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:EARNEY
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:PO BOX 547
Mailing Address - Street 2:128 W MCCONKEY STREET
Mailing Address - City:SHREVE
Mailing Address - State:OH
Mailing Address - Zip Code:44676-0547
Mailing Address - Country:US
Mailing Address - Phone:330-567-3333
Mailing Address - Fax:330-567-5919
Practice Address - Street 1:135 S CLAY ST
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-1307
Practice Address - Country:US
Practice Address - Phone:330-674-8080
Practice Address - Fax:330-674-4876
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH301-01-50841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0001390OtherDORAL DENTAL PROVIDER
OH341807825027OtherCARESOURCE PROVIDER NUMBE
OH0326445Medicaid