Provider Demographics
NPI:1861820516
Name:KANE, ROBERT STEPHEN (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEPHEN
Last Name:KANE
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 1:1646 N LITCHFIELD RD
Mailing Address - Street 2:#260
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1203
Mailing Address - Country:US
Mailing Address - Phone:623-535-7899
Mailing Address - Fax:623-535-7821
Practice Address - Street 1:1646 N LITCHFIELD RD
Practice Address - Street 2:#260
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1203
Practice Address - Country:US
Practice Address - Phone:623-535-7899
Practice Address - Fax:623-535-7821
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32661223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics