Provider Demographics
NPI:1083613632
Name:GURMANKIN, ROBERT S (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:GURMANKIN
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 1:319 VINE ST APT 402
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1130
Mailing Address - Country:US
Mailing Address - Phone:215-964-9887
Mailing Address - Fax:
Practice Address - Street 1:7330 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-3828
Practice Address - Country:US
Practice Address - Phone:215-624-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-17
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024142L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice