Provider Demographics
NPI:1619058328
Name:ROBISON, JON CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:CHRISTOPHER
Last Name:ROBISON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 INTRACOASTAL DR
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3621
Mailing Address - Country:US
Mailing Address - Phone:954-537-5359
Mailing Address - Fax:
Practice Address - Street 1:716 INTRACOASTAL DR
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3621
Practice Address - Country:US
Practice Address - Phone:954-537-5359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN154791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics