Provider Demographics
NPI:1376718981
Name:HALBLEIB, JESSE ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:ALAN
Last Name:HALBLEIB
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 1:4450 CAPITOLA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3570
Mailing Address - Country:US
Mailing Address - Phone:831-462-1612
Mailing Address - Fax:831-462-8545
Practice Address - Street 1:4450 CAPITOLA RD STE 102
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3570
Practice Address - Country:US
Practice Address - Phone:831-462-1612
Practice Address - Fax:831-462-8545
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice