Provider Demographics
NPI:1073723557
Name:DEBAKER, JESSE ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:ROBERT
Last Name:DEBAKER
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 1:110 S VAL VISTA DR STE B7
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1373
Mailing Address - Country:US
Mailing Address - Phone:480-892-4567
Mailing Address - Fax:480-635-8138
Practice Address - Street 1:110 S VAL VISTA DR STE B7
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1373
Practice Address - Country:US
Practice Address - Phone:480-892-4567
Practice Address - Fax:480-635-8138
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice