Healthcare Provider Details

I. General information

NPI: 1134172968
Provider Name (Legal Business Name): ROBERT ALEXANDER HERRIN DDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 SPRINGBANK LN. SUITE A
CHARLOTTE NC
28226
US

IV. Provider business mailing address

3111 SPRINGBANK LN. SUITE A
CHARLOTTE NC
28226
US

V. Phone/Fax

Practice location:
  • Phone: 704-541-3603
  • Fax: 704-541-3619
Mailing address:
  • Phone: 704-541-3603
  • Fax: 704-541-3619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3793
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number24595
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: