Provider Demographics
NPI:1629127956
Name:ROBINSON, ROGER DUANE JR (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DUANE
Last Name:ROBINSON
Suffix:JR
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 CARDINAL POINT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5500
Mailing Address - Country:US
Mailing Address - Phone:904-737-2040
Mailing Address - Fax:904-737-2051
Practice Address - Street 1:3595 CARDINAL POINT DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5500
Practice Address - Country:US
Practice Address - Phone:904-737-2040
Practice Address - Fax:904-737-2051
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN173641223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics