Provider Demographics
NPI:1104240415
Name:ROBERT G. NAKISHER, D.D.S., P.L.L.C
Entity type:Organization
Organization Name:ROBERT G. NAKISHER, D.D.S., P.L.L.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:NAKISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-363-3304
Mailing Address - Street 1:7010 PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2017
Mailing Address - Country:US
Mailing Address - Phone:248-363-3304
Mailing Address - Fax:248-363-0814
Practice Address - Street 1:7010 PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2017
Practice Address - Country:US
Practice Address - Phone:248-363-3304
Practice Address - Fax:248-363-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI99181223G0001X
MI156501223G0001X
MI191621223P0300X
MI160851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty