Provider Demographics
NPI:1184302994
Name:MOUNDBUILDERS GENERAL DENTISTRY, DRS. JUMP AND ROBERTSON LLC
Entity type:Organization
Organization Name:MOUNDBUILDERS GENERAL DENTISTRY, DRS. JUMP AND ROBERTSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-344-1810
Mailing Address - Street 1:1634 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1634 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1540
Practice Address - Country:US
Practice Address - Phone:740-344-1810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental