Provider Demographics
NPI:1649787912
Name:JUBILEE FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:JUBILEE FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BIBIANA
Authorized Official - Middle Name:TELKA
Authorized Official - Last Name:BARBERI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-665-1916
Mailing Address - Street 1:6475 JORDAN RD
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4728
Mailing Address - Country:US
Mailing Address - Phone:251-626-6450
Mailing Address - Fax:
Practice Address - Street 1:6475 JORDAN AVENUE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526
Practice Address - Country:US
Practice Address - Phone:251-626-6450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty