Provider Demographics
NPI:1407059009
Name:JABERI, JOBY E (DDS)
Entity Type:Individual
Prefix:
First Name:JOBY
Middle Name:E
Last Name:JABERI
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 1:1000 E 1ST ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-722-1854
Mailing Address - Fax:218-722-6424
Practice Address - Street 1:1000 E 1ST ST
Practice Address - Street 2:SUITE 302
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2297
Practice Address - Country:US
Practice Address - Phone:218-722-1854
Practice Address - Fax:218-722-6424
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0022997390200000X
MNS491223S0112X
WI6859-151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program