Provider Demographics
NPI:1134705700
Name:J A HALBLEIB DDS A PROFESSIONAL CORP
Entity type:Organization
Organization Name:J A HALBLEIB DDS A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALBLEIB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-331-5280
Mailing Address - Street 1:4450 CAPITOLA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3570
Mailing Address - Country:US
Mailing Address - Phone:831-462-1612
Mailing Address - Fax:831-462-8545
Practice Address - Street 1:1053 S GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4164
Practice Address - Country:US
Practice Address - Phone:831-465-2161
Practice Address - Fax:831-462-8545
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JESSE A HALBLEIB DDS A DENTAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental