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General NPI Number Information
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NPI Number | 1003191099
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Entity Type | Organization
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Legal Business Name | ROGER D. ROBINSON JR., D.M.D., P.A.
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Dates
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Enumeration Date | 10/21/2011
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 3595 CARDINAL POINT DRIVE
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City | JACKSONVILLE
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State | FL
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Zip | 32257
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Country | US
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Telephone | 904-737-2040
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Fax | 904-737-2051
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Provider Business Mailing Address
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Address Line | 3595 CARDINAL POINT DRIVE
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City | JACKSONVILLE
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State | FL
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Zip | 32257
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Country | US
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Telephone | 904-737-2040
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Fax | 904-737-2051
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Authorized Official
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Title or Position | PRESIDENT / PERIODONTIST
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Name | DR. ROGER D ROBINSON JR.
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Credential | D.M.D.
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Telephone | 904-737-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN17364
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License Number State | FL
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