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General NPI Number Information
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NPI Number | 1407062896
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Entity Type | Individual
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Provider Name | DUANE EVERETT ROBERT D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 618 E CARTER AVE
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City | BLACKSHEAR
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State | GA
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Zip | 31516-1559
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Country | US
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Telephone | 912-449-3300
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Fax | 912-807-0219
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Provider Business Mailing Address
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Address Line | 618 E CARTER AVE
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City | BLACKSHEAR
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State | GA
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Zip | 31516-1559
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Country | US
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Telephone | 912-449-3300
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Fax | 912-807-0219
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN009374
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License Number State | GA
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