Healthcare Provider Details

I. General information

NPI: 1922007855
Provider Name (Legal Business Name): JON N ROBINSON DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JON N ROBINSON DMD, MS

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 NE EVELYN AVE STE A-1
GRANTS PASS OR
97526-1427
US

IV. Provider business mailing address

124 NE EVELYN AVE STE A-1
GRANTS PASS OR
97526-1427
US

V. Phone/Fax

Practice location:
  • Phone: 541-479-9701
  • Fax: 541-479-1613
Mailing address:
  • Phone: 541-479-9701
  • Fax: 541-479-1613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD6895
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: