Provider Demographics
NPI:1053537373
Name:KAY, ROBERT ALBERT (DDS MSD SC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALBERT
Last Name:KAY
Suffix:
Gender:M
Credentials:DDS MSD SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 WEST UPHAM STREET
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449
Mailing Address - Country:US
Mailing Address - Phone:715-387-1017
Mailing Address - Fax:715-384-7098
Practice Address - Street 1:314 WEST UPHAM STREET
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449
Practice Address - Country:US
Practice Address - Phone:715-387-1017
Practice Address - Fax:715-384-7098
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40018930151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33652000Medicaid