Provider Demographics
NPI:1487140174
Name:ROBINSON, JONATHAN DWYTE (DMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DWYTE
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 1:6910 ROANOKE RD
Mailing Address - Street 2:
Mailing Address - City:SHAWSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24162
Mailing Address - Country:US
Mailing Address - Phone:910-850-5432
Mailing Address - Fax:
Practice Address - Street 1:6910 ROANOKE RD
Practice Address - Street 2:
Practice Address - City:SHAWSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24162
Practice Address - Country:US
Practice Address - Phone:910-850-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416138122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist