Provider Demographics
NPI:1144386673
Name:GUMINEY, ROBERT S (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:GUMINEY
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 1:250 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3031
Mailing Address - Country:US
Mailing Address - Phone:281-203-7897
Mailing Address - Fax:
Practice Address - Street 1:250 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3031
Practice Address - Country:US
Practice Address - Phone:281-203-7897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30012873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist