Provider Demographics
NPI:1922104231
Name:HARRELL, ROBERT KENNETH (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KENNETH
Last Name:HARRELL
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 1:511 E LAUCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5502
Mailing Address - Country:US
Mailing Address - Phone:910-276-1144
Mailing Address - Fax:910-277-8411
Practice Address - Street 1:511 E LAUCHWOOD DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5502
Practice Address - Country:US
Practice Address - Phone:910-276-1144
Practice Address - Fax:910-277-8411
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993582Medicaid
NCU39062Medicare UPIN