Provider Demographics
NPI:1629290135
Name:GANO, ROBERT CLAUDE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLAUDE
Last Name:GANO
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 1:11887 CRESSEY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080
Mailing Address - Country:US
Mailing Address - Phone:269-664-5222
Mailing Address - Fax:
Practice Address - Street 1:5462 GULL RD SUITE 7
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048
Practice Address - Country:US
Practice Address - Phone:269-373-1999
Practice Address - Fax:269-373-1959
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0163171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice