Healthcare Provider Details

I. General information

NPI: 1376822460
Provider Name (Legal Business Name): JESSICA ANN ROEBER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5375 KEARNY VILLA RD STE 103
SAN DIEGO CA
92123-1422
US

IV. Provider business mailing address

1804 GARNET AVE # 105
SAN DIEGO CA
92109-3352
US

V. Phone/Fax

Practice location:
  • Phone: 970-210-5315
  • Fax:
Mailing address:
  • Phone: 970-210-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10532
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number106083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: