Provider Demographics
NPI:1962501643
Name:ROBLING, JACY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACY
Middle Name:D
Last Name:ROBLING
Suffix:
Gender:F
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:PO BOX 1099
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-0693
Mailing Address - Country:US
Mailing Address - Phone:765-362-9245
Mailing Address - Fax:765-362-9250
Practice Address - Street 1:116 WALTER REMLEY DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-3350
Practice Address - Country:US
Practice Address - Phone:765-362-9245
Practice Address - Fax:765-362-9250
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010461A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice