Provider Demographics
NPI:1568563195
Name:JARBOE, LINA (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:LINA
Middle Name:
Last Name:JARBOE
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6077
Mailing Address - Country:US
Mailing Address - Phone:410-203-1800
Mailing Address - Fax:
Practice Address - Street 1:6021 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6077
Practice Address - Country:US
Practice Address - Phone:410-203-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD95841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics