Provider Demographics
NPI:1972812667
Name:ROBBY JENNINGS DENTISTRY PLLC
Entity Type:Organization
Organization Name:ROBBY JENNINGS DENTISTRY PLLC
Other - Org Name:SHILOH FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-581-5500
Mailing Address - Street 1:5011 TROUP HWY # 700
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-1917
Mailing Address - Country:US
Mailing Address - Phone:903-581-5500
Mailing Address - Fax:
Practice Address - Street 1:5011 TROUP HWY # 700
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-1917
Practice Address - Country:US
Practice Address - Phone:903-581-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty