Provider Demographics
NPI:1912115585
Name:OUTLAND, ROBERT BOONE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BOONE
Last Name:OUTLAND
Suffix:JR
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:BOX 410
Mailing Address - Street 2:504 SOUTH MAIN STREET
Mailing Address - City:RICH SQUARE
Mailing Address - State:NC
Mailing Address - Zip Code:27869
Mailing Address - Country:US
Mailing Address - Phone:252-539-2260
Mailing Address - Fax:252-539-3929
Practice Address - Street 1:504 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:RICH SQUARE
Practice Address - State:NC
Practice Address - Zip Code:27869
Practice Address - Country:US
Practice Address - Phone:252-539-2260
Practice Address - Fax:252-539-3929
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2913122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist