Provider Demographics
NPI:1790876977
Name:NAKISHER, ROBERT GORDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GORDON
Last Name:NAKISHER
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 1:7010 PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2017
Mailing Address - Country:US
Mailing Address - Phone:248-363-3304
Mailing Address - Fax:
Practice Address - Street 1:7010 PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2017
Practice Address - Country:US
Practice Address - Phone:248-363-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI160851223G0001X
MI2901016085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice