Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DI15671 | NJ |
NPI | 1124166673 |
---|---|
Provider Name | Dr. Robert Bruce Kane |
First Address | Toms River, NJ 08755-4973 |
Second Address | Toms River, NJ 08755-4973 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2007 |
Last Update Date | 08/07/2007 |