Provider Demographics
NPI:1306964903
Name:DANIEL, ROBERT HARRIS JR (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:HARRIS
Last Name:DANIEL
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:PO BOX 10
Mailing Address - Street 2:5706 MCLEANSVILLE RD
Mailing Address - City:MCLEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301
Mailing Address - Country:US
Mailing Address - Phone:336-697-0618
Mailing Address - Fax:336-697-9478
Practice Address - Street 1:5706 MCLEANSVILLE RD
Practice Address - Street 2:
Practice Address - City:MCLEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301
Practice Address - Country:US
Practice Address - Phone:336-697-0618
Practice Address - Fax:336-697-9478
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist