Provider Demographics
NPI:1831308204
Name:ROBINSON, JESSICA JOHNSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JOHNSON
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 KENSINGTON COURT
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532
Mailing Address - Country:US
Mailing Address - Phone:205-410-7167
Mailing Address - Fax:
Practice Address - Street 1:8477A COUNTY ROAD 64 STE 3
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-8715
Practice Address - Country:US
Practice Address - Phone:251-621-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice