Provider Demographics
NPI:1457358251
Name:CARR, ROBERT STERLING (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STERLING
Last Name:CARR
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:PO BOX 1133
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:OR
Mailing Address - Zip Code:97882-1133
Mailing Address - Country:US
Mailing Address - Phone:541-922-4561
Mailing Address - Fax:541-922-2317
Practice Address - Street 1:200 6TH ST
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:OR
Practice Address - Zip Code:97882
Practice Address - Country:US
Practice Address - Phone:541-922-4561
Practice Address - Fax:541-922-2317
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-09
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
OR50331223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR00922500OtherBLUE CROSS OF OR PROVIDER
OR048074Medicaid