Provider Demographics
NPI:1386624922
Name:ROBERT, CHA (DDS)
Entity type:Individual
Prefix:DR
First Name:CHA
Middle Name:
Last Name:ROBERT
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 1:1168 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6426
Mailing Address - Country:US
Mailing Address - Phone:201-969-2828
Mailing Address - Fax:973-622-1710
Practice Address - Street 1:573 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1215
Practice Address - Country:US
Practice Address - Phone:973-622-3614
Practice Address - Fax:973-622-1710
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020149011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice