Provider Demographics
NPI:1619350147
Name:KOBY, JESSICA (DMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KOBY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 YELM HWY SE
Mailing Address - Street 2:STE E
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5034
Mailing Address - Country:US
Mailing Address - Phone:360-528-7878
Mailing Address - Fax:
Practice Address - Street 1:5122 YELM HWY SE
Practice Address - Street 2:STE E
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5034
Practice Address - Country:US
Practice Address - Phone:360-528-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60691606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist