Individual provider Active NPI

Robert F. Cannis, DMD

  • Dentist
  • Lakewood, NJ
National Provider Identifier
1841213782
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22DI01053800 Issued in NJ
Practice address
1200 River Ave
Suite 3B
Lakewood, NJ 08701-5657
Phone
(732) 367-8200
Fax
(732) 367-8209
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 22DI01053800 NJ Primary

Addresses

Primary practice location

1200 River Ave
Suite 3B
Lakewood, NJ 08701-5657

Mailing address

1200 River Ave
Suite 3B
Lakewood, NJ 08701-5657
Phone (732) 367-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160224000311 NJ Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 9436454774

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22DI01053800NJMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841213782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 RIVER AVE",
            "address_2": "SUITE 3B",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015657",
            "telephone_number": "732-367-8200",
            "fax_number": "732-367-8209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 RIVER AVE",
            "address_2": "SUITE 3B",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015657",
            "telephone_number": "732-367-8200",
            "fax_number": "732-367-8209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNIS",
        "first_name": "ROBERT",
        "middle_name": "F.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI01053800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

Verify at the official NPI Registry.