Provider Demographics
NPI:1821527714
Name:ROBISON, DAMON CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:CHARLES
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 1:300 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:MO
Mailing Address - Zip Code:65781-9536
Mailing Address - Country:US
Mailing Address - Phone:417-742-3700
Mailing Address - Fax:417-742-4475
Practice Address - Street 1:300 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:MO
Practice Address - Zip Code:65781-9536
Practice Address - Country:US
Practice Address - Phone:417-742-3700
Practice Address - Fax:417-742-4475
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170174101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice