Jolyn Rae Jaberi, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D13151 Issued in MN

Practice address

16670 Franklin TRL SE Ste 100
Prior Lake, MN 55372-2926

Phone

(952) 447-4611

Fax

(952) 447-4660

NPI assigned

Aug 14, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1144577602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16670 FRANKLIN TRL SE STE 100",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553722926",
            "telephone_number": "952-447-4611",
            "fax_number": "952-447-4660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16670 FRANKLIN TRL SE STE 100",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553722926",
            "telephone_number": "952-447-4611",
            "fax_number": "952-447-4660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JABERI",
        "first_name": "JOLYN",
        "middle_name": "RAE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-14",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Claire Hittner-Ashwell, LICSW
• Bridget Nicole Holbrook, PA-C
• Todd H Holm, M.D.
• Katherine Ann Huntington, PA
• Doreen Lubi Isubikalu
• Kristen Marie Jackson, MA, LPCC
• Allen Jerome Johnson
• Kathryn Lynn Jonsrud, R.PH
• Charles Howard Jorenby, MA, LP
• Zachary Thomas Kahmeyer, M.A., LPCC

• Dentist in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.