Provider Demographics
NPI:1639552854
Name:HOBBY, JAHURA (RDH)
Entity Type:Individual
Prefix:MS
First Name:JAHURA
Middle Name:
Last Name:HOBBY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3742
Mailing Address - Country:US
Mailing Address - Phone:313-415-3863
Mailing Address - Fax:
Practice Address - Street 1:3000 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2372
Practice Address - Country:US
Practice Address - Phone:313-393-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902017454124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist