Provider Demographics
NPI:1750578027
Name:WITHERSPOON, ROBERT ALLEN (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLEN
Last Name:WITHERSPOON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:ALLEN
Other - Last Name:WITHERSPOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:4100 HIDDEN FERN LN N
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-9101
Mailing Address - Country:US
Mailing Address - Phone:901-734-1833
Mailing Address - Fax:901-382-7137
Practice Address - Street 1:4100 HIDDEN FERN LN N
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-9101
Practice Address - Country:US
Practice Address - Phone:901-734-1833
Practice Address - Fax:901-382-7137
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice