Individual
ROBERT ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
315 MCHUGH BLVD, 2D DENBN/NDC, CAMP LEJEUNE, NC 28547-2511
(910) 451-2208
(910) 451-8036
Mailing address
315 MCHUGH BLVD, 2D DENBN/NDC, CAMP LEJEUNE, NC 28547-2511
(910) 451-2208
(910) 451-8036
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401005942
VA
Other
Enumeration date
01/20/2006
Last updated
09/24/2008
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