Provider Demographics
NPI:1194976332
Name:ROBINSON, JEFFREY BLAINE (DMD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BLAINE
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 TWINING DR
Mailing Address - Street 2:
Mailing Address - City:BARKSDALE AFB
Mailing Address - State:LA
Mailing Address - Zip Code:71110-2486
Mailing Address - Country:US
Mailing Address - Phone:318-456-2743
Mailing Address - Fax:
Practice Address - Street 1:BAFB DENTAL CLINIC OMS
Practice Address - Street 2:1067 TWINING DR
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110-2486
Practice Address - Country:US
Practice Address - Phone:318-456-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-41771223G0001X
CODEN.002057121223S0112X
LA69181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice