Provider Demographics
NPI:1487730669
Name:KANE, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17900 TALBOT RD. S. # 103
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055
Mailing Address - Country:US
Mailing Address - Phone:425-271-1727
Mailing Address - Fax:425-271-1763
Practice Address - Street 1:10217 125TH STREET CT E FL 3
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2761
Practice Address - Country:US
Practice Address - Phone:253-864-4760
Practice Address - Fax:253-864-4766
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006288122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist