Provider Demographics
NPI:1679551162
Name:KANAS, ROBERT J (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:KANAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 432
Mailing Address - Street 2:368 CANTLEY ST
Mailing Address - City:LAKEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48367
Mailing Address - Country:US
Mailing Address - Phone:248-763-4447
Mailing Address - Fax:
Practice Address - Street 1:368 CANTLEY ST
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:MI
Practice Address - Zip Code:48367-6602
Practice Address - Country:US
Practice Address - Phone:248-763-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15010122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist