Provider Demographics
NPI:1699032169
Name:ROBBY JENNINGS DENTISTRY
Entity Type:Organization
Organization Name:ROBBY JENNINGS DENTISTRY
Other - Org Name:SHILOH FAMILY DENTAL PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-581-5500
Mailing Address - Street 1:5011 TROUP HWY # 700
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-1917
Mailing Address - Country:US
Mailing Address - Phone:903-581-5500
Mailing Address - Fax:903-581-5510
Practice Address - Street 1:5011 TROUP HWY # 700
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-1917
Practice Address - Country:US
Practice Address - Phone:903-581-5500
Practice Address - Fax:903-581-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty