1922007855 NPI number — JON N ROBINSON DMD, MS

Table of content: JON N ROBINSON DMD, MS (NPI 1922007855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922007855 NPI number — JON N ROBINSON DMD, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
JON
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD, MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBINSON
Provider Other First Name:
JON
Provider Other Middle Name:
N
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD, MS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1922007855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1228 NE 7TH ST
Provider Second Line Business Mailing Address:
SUITE A-1
Provider Business Mailing Address City Name:
GRANTS PASS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97526-1445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-479-9701
Provider Business Mailing Address Fax Number:
541-479-1613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1228 NE 7TH ST
Provider Second Line Business Practice Location Address:
SUITE A-1
Provider Business Practice Location Address City Name:
GRANTS PASS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97526-1445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-479-9701
Provider Business Practice Location Address Fax Number:
541-479-1613
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  D6895 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1673755 . This is a "UNITED CONCORDIA TDP" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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