Robert Etheridge, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401005942 Issued in VA

Practice address

315 McHugh Blvd
2D Denbn/NDC
Camp Lejeune, NC 28547-2511

Phone

(910) 451-2208

Fax

(910) 451-8036

NPI assigned

Jan 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222214400000",
    "number": "1629058938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 MCHUGH BLVD",
            "address_2": "2D DENBN/NDC",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "285472511",
            "telephone_number": "910-451-2208",
            "fax_number": "910-451-8036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 MCHUGH BLVD",
            "address_2": "2D DENBN/NDC",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "285472511",
            "telephone_number": "910-451-2208",
            "fax_number": "910-451-8036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHERIDGE",
        "first_name": "ROBERT",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2008-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401005942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chanda English, IDC
• Thomas Patrick English, MD
• James J Epperly Jr., D.O.
• Zachary James Eschenberg, DDS
• Claire Jacqueline Esposito, M.D.
• Reginald S. Ewing III, MD
• Christopher Fahlsing, MD
• Vincent Falcetta
• Mackenzie Fall
• Merrie Catherine Fannin, COTA

• General Practice Dentistry in Camp Lejeune, NC
• Providers in Camp Lejeune, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.