Provider Demographics
NPI:1447489265
Name:RODELSPERGER, ROBERT PETER (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PETER
Last Name:RODELSPERGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WINDERMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7411
Mailing Address - Country:US
Mailing Address - Phone:843-225-0111
Mailing Address - Fax:
Practice Address - Street 1:53 WINDERMERE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7411
Practice Address - Country:US
Practice Address - Phone:843-225-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist