Provider Demographics
NPI:1215149448
Name:ROBICHAUD, JEFFREY A (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:ROBICHAUD
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 1:495 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1319
Mailing Address - Country:US
Mailing Address - Phone:517-266-9010
Mailing Address - Fax:
Practice Address - Street 1:231 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MORENCI
Practice Address - State:MI
Practice Address - Zip Code:49256-1420
Practice Address - Country:US
Practice Address - Phone:517-458-6525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0147391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice