MEDICARE: DR. ROBERT F. CANNIS DMD

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	22DI01053800	NJ

General Provider Information

NPI Number	:	1841213782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT F. CANNIS DMD

Provider Business Mailing Address
First Line	:	1200 RIVER AVE
Second Line	:	SUITE 3B
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5657
Country	:	US
Telephone Number	:	732-367-8200
Fax Number	:	732-367-8209

Provider Business Practice Location Address
First Line	:	1200 RIVER AVE
Second Line	:	SUITE 3B
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5657
Country	:	US
Telephone Number	:	732-367-8200
Fax Number	:	732-367-8209

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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