Provider Demographics
NPI:1669672333
Name:GABY, JESSICA SHIRLEY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SHIRLEY
Last Name:GABY
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 1:1024 8TH ST
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-1306
Mailing Address - Country:US
Mailing Address - Phone:208-436-0734
Mailing Address - Fax:
Practice Address - Street 1:1024 8TH ST
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-1306
Practice Address - Country:US
Practice Address - Phone:208-436-0734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1943124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist