Provider Demographics
NPI:1386015352
Name:JEREMY ROBINSON DDS PLLC
Entity Type:Organization
Organization Name:JEREMY ROBINSON DDS PLLC
Other - Org Name:ROBINSON DENTALCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-520-8880
Mailing Address - Street 1:738 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4230
Mailing Address - Country:US
Mailing Address - Phone:931-520-8880
Mailing Address - Fax:931-520-8889
Practice Address - Street 1:738 E SPRING ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4230
Practice Address - Country:US
Practice Address - Phone:931-520-8880
Practice Address - Fax:931-520-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS7982122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF51Medicaid