Healthcare Provider Details

I. General information

NPI: 1144386673
Provider Name (Legal Business Name): ROBERT S GUMINEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S CHESTNUT ST
RAVENNA OH
44266-3031
US

IV. Provider business mailing address

250 S CHESTNUT ST
RAVENNA OH
44266-3031
US

V. Phone/Fax

Practice location:
  • Phone: 281-203-7897
  • Fax:
Mailing address:
  • Phone: 281-203-7897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30012873
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: