Provider Demographics
NPI:1144577602
Name:JABERI, JOLYN RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOLYN
Middle Name:RAE
Last Name:JABERI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16670 FRANKLIN TRL SE STE 100
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2926
Mailing Address - Country:US
Mailing Address - Phone:952-447-4611
Mailing Address - Fax:952-447-4660
Practice Address - Street 1:16670 FRANKLIN TRL SE STE 100
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-2926
Practice Address - Country:US
Practice Address - Phone:952-447-4611
Practice Address - Fax:952-447-4660
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13151122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist