Robert M Haberkorn, DDS,MBA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

SC6951 Issued in SC

Practice address

1987 Allendale-Fairfax Hwy
Fairfax, SC 29827

Phone

(803) 632-3301

NPI assigned

Oct 25, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Robert M. Haberkorn DDS

  • Dental Clinic/Center
  • Fairfax, SC
  • NPI 1154606440
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430784000000",
    "number": "1497745012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1987 ALLENDALE-FAIRFAX HWY",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "29827",
            "telephone_number": "803-632-3301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1987 ALLENDALE-FAIRFAX HWY",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "29827",
            "telephone_number": "803-632-3301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HABERKORN",
        "first_name": "ROBERT",
        "middle_name": "M",
        "credential": "DDS,MBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-25",
        "last_updated": "2015-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2002031756",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "SC6951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fairfax Pharmacy Inc.
• Fairfax Pharmacy Inc.
• Jerlesa Frazier-Harney, RN
• Christopher Michael Gamboa, MD
• Lewis Edward Gore III, PT, DPT
• Angela Hardin, PTA
• Azalyn Hickman, OTRL
• Honest Way Transportation LLC
• Charles Taylor Hudson
• Robert M Jones, MD

• All providers in Fairfax, SC
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.