Provider Demographics
NPI:1750580973
Name:CHMIEL, ROBERT ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:CHMIEL
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 1:777 MAPLE RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3275
Mailing Address - Country:US
Mailing Address - Phone:716-634-4900
Mailing Address - Fax:716-633-5800
Practice Address - Street 1:777 MAPLE RD
Practice Address - Street 2:SUITE #3
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3275
Practice Address - Country:US
Practice Address - Phone:716-634-4900
Practice Address - Fax:716-633-5800
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0435431223G0001X
CO82491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01251927Medicaid