Provider Demographics
NPI:1306559349
Name:ROBBINS, JONATHAN D (RHD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:RHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 ALAMEDA BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-8807
Mailing Address - Country:US
Mailing Address - Phone:505-200-9399
Mailing Address - Fax:
Practice Address - Street 1:1628 ALAMEDA BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-8807
Practice Address - Country:US
Practice Address - Phone:505-200-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH22009124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist