Provider Demographics
NPI:1922007855
Name:ROBINSON, JON N (DMD, MS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:N
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:JON
Other - Middle Name:N
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:1228 NE 7TH ST
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1445
Mailing Address - Country:US
Mailing Address - Phone:541-479-9701
Mailing Address - Fax:541-479-1613
Practice Address - Street 1:1228 NE 7TH ST
Practice Address - Street 2:SUITE A-1
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1445
Practice Address - Country:US
Practice Address - Phone:541-479-9701
Practice Address - Fax:541-479-1613
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD68951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1673755OtherUNITED CONCORDIA TDP