Provider Demographics
NPI:1801269261
Name:ROBINSON, JAMES KOLBY (DMD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KOLBY
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 FIELDBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:80238-2506
Mailing Address - Country:US
Mailing Address - Phone:801-808-6934
Mailing Address - Fax:
Practice Address - Street 1:1291 E. MCANDREWS RD.
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:80238-2506
Practice Address - Country:US
Practice Address - Phone:541-779-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202440122300000X
OR104521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist