Provider Demographics
NPI:1699858787
Name:DABY, JEROME JARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:JARL
Last Name:DABY
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 1:2409 L ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5025
Mailing Address - Country:US
Mailing Address - Phone:916-443-8908
Mailing Address - Fax:916-443-1763
Practice Address - Street 1:2409 L ST
Practice Address - Street 2:SUITE #3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5025
Practice Address - Country:US
Practice Address - Phone:916-443-8908
Practice Address - Fax:916-443-1763
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA033744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist