Provider Demographics
NPI:1619072279
Name:D AMOUR, ROBERT JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:D AMOUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 WOODWARD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802
Mailing Address - Country:US
Mailing Address - Phone:906-774-0220
Mailing Address - Fax:906-774-1314
Practice Address - Street 1:1075 WOODWARD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KINGSFORD
Practice Address - State:MI
Practice Address - Zip Code:49802
Practice Address - Country:US
Practice Address - Phone:906-774-0220
Practice Address - Fax:906-774-1314
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14520 MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IZ23G0001XMedicare UPIN