Provider Demographics
NPI:1497830889
Name:CHRISTY, JEBEDIAH SHEPHERD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEBEDIAH
Middle Name:SHEPHERD
Last Name:CHRISTY
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:PO BOX 5577
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-5577
Mailing Address - Country:US
Mailing Address - Phone:603-520-9786
Mailing Address - Fax:
Practice Address - Street 1:36 ENDICOTT STREET EAST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03247-5577
Practice Address - Country:US
Practice Address - Phone:603-520-9786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03540122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30304351Medicaid