Provider Demographics
NPI:1598807232
Name:CHICK, ROBERT MALCOLM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MALCOLM
Last Name:CHICK
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 1:978 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-3247
Mailing Address - Country:US
Mailing Address - Phone:716-694-3040
Mailing Address - Fax:716-694-9615
Practice Address - Street 1:978 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:N TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-3247
Practice Address - Country:US
Practice Address - Phone:716-694-3040
Practice Address - Fax:716-694-9615
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
NY0268601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice