MEDICARE: DR. ROBERT J KANAS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	15010	MI

General Provider Information

NPI Number	:	1679551162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J KANAS DDS

Provider Business Mailing Address
First Line	:	P.O. BOX 432
Second Line	:	368 CANTLEY ST
City	:	LAKEVILLE
State	:	MI
Zip	:	48367
Country	:	US
Telephone Number	:	248-763-4447
Fax Number	:

Provider Business Practice Location Address
First Line	:	368 CANTLEY ST
Second Line	:
City	:	LEONARD
State	:	MI
Zip	:	48367-6602
Country	:	US
Telephone Number	:	248-763-4447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	06/25/2015

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