MEDICARE: MR. ROBERT C CARRIS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	13069	TX

General Provider Information

NPI Number	:	1285710475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT C CARRIS DDS

Provider Business Mailing Address
First Line	:	4815 MILL CREEK PL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-6913
Country	:	US
Telephone Number	:	214-353-2787
Fax Number	:	214-353-9477

Provider Business Practice Location Address
First Line	:	5200 VILLAGE CREEK DR STE 102
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4429
Country	:	US
Telephone Number	:	214-353-2787
Fax Number	:	214-353-9477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	12/13/2023

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