Provider Demographics
NPI:1083147367
Name:ROBBINS, JORDAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:TORRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4102 PINION DR
Mailing Address - Street 2:
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-2502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23RD MEDICAL GROUP 3278 MITCHELL BLVD
Practice Address - Street 2:
Practice Address - City:MOODY AFB
Practice Address - State:GA
Practice Address - Zip Code:31699
Practice Address - Country:US
Practice Address - Phone:229-257-1459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22566122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist