Provider Demographics
NPI:1558403329
Name:KAMANSKY, ROBERT FLYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FLYNN
Last Name:KAMANSKY
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 1:1251 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2143
Mailing Address - Country:US
Mailing Address - Phone:909-981-1184
Mailing Address - Fax:
Practice Address - Street 1:1251 W 15TH ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2143
Practice Address - Country:US
Practice Address - Phone:909-981-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist