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General NPI Number Information
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NPI Number | 1255519575
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Entity Type | Organization
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Legal Business Name | ROBBY JENNINGS DENTAL
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 209 W 8TH ST
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City | TYLER
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State | TX
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Zip | 75701-4102
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Country | US
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Telephone | 903-597-3940
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Fax | 903-526-2631
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Provider Business Mailing Address
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Address Line | 2002 S STEMMONS FWY STE 500
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City | LAKE DALLAS
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State | TX
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Zip | 75065-3633
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Country | US
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Telephone | 940-321-2053
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Fax | 940-321-2054
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. WILLIAM ROBERT JENNINGS JR.
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Credential | DDS
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Telephone | 903-597-3940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 18962
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License Number State | TX
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