MEDICARE: ROBERT STEPHEN KANE 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	1223E0200X	Endodontics	3266	AZ

General Provider Information

NPI Number	:	1861820516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT STEPHEN KANE DDS

Provider Business Mailing Address
First Line	:	1646 N LITCHFIELD RD
Second Line	:	#260
City	:	GOODYEAR
State	:	AZ
Zip	:	85395-1203
Country	:	US
Telephone Number	:	623-535-7899
Fax Number	:	623-535-7821

Provider Business Practice Location Address
First Line	:	1646 N LITCHFIELD RD
Second Line	:	#260
City	:	GOODYEAR
State	:	AZ
Zip	:	85395-1203
Country	:	US
Telephone Number	:	623-535-7899
Fax Number	:	623-535-7821

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

Provider Enumeration Date	:	10/16/2013
Last Update Date	:	10/16/2013

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