Provider Demographics
NPI:1780664508
Name:JANSEN, ROBERT W (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:JANSEN
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 1:923 N OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-1063
Mailing Address - Country:US
Mailing Address - Phone:989-224-2968
Mailing Address - Fax:989-224-2474
Practice Address - Street 1:923 N OAKLAND ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-1063
Practice Address - Country:US
Practice Address - Phone:989-224-2968
Practice Address - Fax:989-224-2474
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0139061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice