Provider Demographics
NPI:1275408197
Name:DR. ROBERT D SELF, DDS
Entity type:Organization
Organization Name:DR. ROBERT D SELF, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-586-5382
Mailing Address - Street 1:216 E 1ST NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-4710
Mailing Address - Country:US
Mailing Address - Phone:423-586-5382
Mailing Address - Fax:
Practice Address - Street 1:216 E 1ST NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4710
Practice Address - Country:US
Practice Address - Phone:423-586-5382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty