Provider Demographics
NPI:1831419571
Name:JOOBBANI, JENNIFER RUTH (DDS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RUTH
Last Name:JOOBBANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 HIGHLAND RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5837
Mailing Address - Country:US
Mailing Address - Phone:919-619-3703
Mailing Address - Fax:
Practice Address - Street 1:15441 PEACH LEAF DR
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-2344
Practice Address - Country:US
Practice Address - Phone:919-619-3703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014138181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice