Provider Demographics
NPI:1649328642
Name:ROBBINS, JACKIE G (DDS)
Entity type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:G
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 MISSOURI AVENUE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836
Mailing Address - Country:US
Mailing Address - Phone:417-358-3361
Mailing Address - Fax:417-358-4222
Practice Address - Street 1:1604 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-3059
Practice Address - Country:US
Practice Address - Phone:417-358-3361
Practice Address - Fax:417-358-4222
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice