Healthcare Provider Details

I. General information

NPI: 1972812667
Provider Name (Legal Business Name): ROBBY JENNINGS DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 TROUP HWY # 700
TYLER TX
75707-1917
US

IV. Provider business mailing address

5011 TROUP HWY # 700
TYLER TX
75707-1917
US

V. Phone/Fax

Practice location:
  • Phone: 903-581-5500
  • Fax:
Mailing address:
  • Phone: 903-581-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18962
License Number StateTX

VIII. Authorized Official

Name: DR. WILLIAM ROBERT JENNINGS JR.
Title or Position: OWNER
Credential: DDS
Phone: 903-581-5500