Provider Demographics
NPI:1851008684
Name:DR ROBERT C GANO, DDS
Entity Type:Organization
Organization Name:DR ROBERT C GANO, DDS
Other - Org Name:GULL ROAD DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:GANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-330-9149
Mailing Address - Street 1:5462 GULL RD STE 7
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1072
Mailing Address - Country:US
Mailing Address - Phone:269-373-1999
Mailing Address - Fax:
Practice Address - Street 1:5462 GULL RD STE 7
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1072
Practice Address - Country:US
Practice Address - Phone:269-373-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty