Provider Demographics
NPI:1255519575
Name:ROBBY JENNINGS DENTAL
Entity type:Organization
Organization Name:ROBBY JENNINGS DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
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:903-597-3940
Mailing Address - Street 1:2002 S STEMMONS FWY STE 500
Mailing Address - Street 2:
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065-3633
Mailing Address - Country:US
Mailing Address - Phone:940-321-2053
Mailing Address - Fax:940-321-2054
Practice Address - Street 1:209 W 8TH ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4102
Practice Address - Country:US
Practice Address - Phone:903-597-3940
Practice Address - Fax:903-526-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty