MEDICARE: DR. JESSICA ANN ROEBER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	106083	CA
2	122300000X	Dentist	10532	CO

General Provider Information

NPI Number	:	1376822460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA ANN ROEBER D.D.S.

Provider Business Mailing Address
First Line	:	1804 GARNET AVE # 105
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3352
Country	:	US
Telephone Number	:	970-210-5315
Fax Number	:

Provider Business Practice Location Address
First Line	:	5375 KEARNY VILLA RD STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1422
Country	:	US
Telephone Number	:	970-210-5315
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2011
Last Update Date	:	01/19/2024

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