Provider Demographics
NPI:1649465675
Name:ROBINSON, NANCY JO (DMD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JO
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 E SOUTHERN AVE
Mailing Address - Street 2:#C
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-730-0553
Mailing Address - Fax:480-839-3319
Practice Address - Street 1:2043 E SOUTHERN AVE
Practice Address - Street 2:#C
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-730-0553
Practice Address - Fax:480-839-3319
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice