Provider Demographics
NPI:1285801530
Name:KIDDER, ROBERT S (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:KIDDER
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 1:4370 STARKEY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0603
Mailing Address - Country:US
Mailing Address - Phone:540-989-9070
Mailing Address - Fax:540-989-9071
Practice Address - Street 1:4370 STARKEY RD
Practice Address - Street 2:STE 3
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0607
Practice Address - Country:US
Practice Address - Phone:540-989-9070
Practice Address - Fax:540-989-9071
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010056151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics