Provider Demographics
NPI:1134275092
Name:BARBOUR, ROBERT K (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:BARBOUR
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 1:1237 GEORGE WASHINGTON HWY N
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-5035
Mailing Address - Country:US
Mailing Address - Phone:757-487-3006
Mailing Address - Fax:757-485-7307
Practice Address - Street 1:2520 GILMERTON RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-4906
Practice Address - Country:US
Practice Address - Phone:757-487-4121
Practice Address - Fax:757-485-7307
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010061331223G0001X
KY52071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6233OtherDELTACARE PROV ID
VA645833OtherUCCI ID NUMBER
VA29589OtherAETNA DMO PROV ID
VA117164OtherCIGNA PROV ID