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General NPI Number Information
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NPI Number | 1154606440
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Entity Type | Organization
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Legal Business Name | ROBERT M. HABERKORN DDS
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Dates
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Enumeration Date | 10/18/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 1987 ALLENDALE FAIRFAX HWY.
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City | FAIRFAX
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State | SC
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Zip | 29827
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Country | US
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Telephone | 803-632-3301
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 368
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City | FAIRFAX
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State | SC
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Zip | 29827
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Country | US
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Telephone | 803-632-3301
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT M HABERKORN
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Credential | DDS, MBA
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Telephone | 803-632-3301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 6951
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License Number State | SC
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