Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 0401005674 | VA |
NPI | 1386617702 |
---|---|
Provider Name | Dr. Robert E. Easterling II |
First Address | Richmond, VA 23273-0001 |
Second Address | Richmond, VA 23228-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 08/07/2007 |