Healthcare Provider Details

I. General information

NPI: 1376522458
Provider Name (Legal Business Name): JESSE A HOBBS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4714 MARSHALL AVE
NEWPORT NEWS VA
23607-2247
US

IV. Provider business mailing address

4714 MARSHALL AVE
NEWPORT NEWS VA
23607-2247
US

V. Phone/Fax

Practice location:
  • Phone: 757-380-8709
  • Fax: 757-928-0902
Mailing address:
  • Phone: 757-380-8709
  • Fax: 757-928-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401005077
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: