Provider Demographics
NPI:1962695353
Name:ROBISON, JOHN DERRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DERRICK
Last Name:ROBISON
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 1:8504 N CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1310
Mailing Address - Country:US
Mailing Address - Phone:734-453-6320
Mailing Address - Fax:734-453-0467
Practice Address - Street 1:8504 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1310
Practice Address - Country:US
Practice Address - Phone:734-453-6320
Practice Address - Fax:734-453-0467
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist