Provider Demographics
NPI:1700597010
Name:NIERMAN, ROBERT (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:NIERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12178 FAZIO DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-0122
Mailing Address - Country:US
Mailing Address - Phone:260-415-5919
Mailing Address - Fax:
Practice Address - Street 1:10120 AUBURN PARK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2392
Practice Address - Country:US
Practice Address - Phone:260-426-8061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013808A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice