Provider Demographics
NPI:1497828941
Name:ABERNATHY, ROBERT E (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:ABERNATHY
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 1:328 SE WILLIAMSBURG CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063
Mailing Address - Country:US
Mailing Address - Phone:816-524-5642
Mailing Address - Fax:
Practice Address - Street 1:4801 CLIFF DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055
Practice Address - Country:US
Practice Address - Phone:167-950-9999
Practice Address - Fax:816-795-0298
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist