Provider Demographics
NPI:1447532346
Name:GAUSMANN, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GAUSMANN
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 1:11 REBECCA DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-1327
Mailing Address - Country:US
Mailing Address - Phone:317-243-0775
Mailing Address - Fax:
Practice Address - Street 1:2225 CENTRAL AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-4487
Practice Address - Country:US
Practice Address - Phone:812-372-7831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010985A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice