Provider Demographics
NPI:1679358907
Name:ROBEY, JENCEN (DDS)
Entity type:Individual
Prefix:
First Name:JENCEN
Middle Name:
Last Name:ROBEY
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 1:230 SE CABOT DR STE 1
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3700
Mailing Address - Country:US
Mailing Address - Phone:360-675-2942
Mailing Address - Fax:
Practice Address - Street 1:230 SE CABOT DR STE 1
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3700
Practice Address - Country:US
Practice Address - Phone:360-675-2942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA614646661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61464666OtherDENTAL LICENSE