Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery | |
Oral and Maxillofacial Surgery |
1223S0112X | 19 | Oral Surgery (Dentist only) |
| NPI Number | 1518141100 |
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| LBN Legal business name | MICHAEL L BOBO DDS MD PSC | ||||||||||||||||||||||||
| Authorized official | MICHAEL BOBO - (OWNER/PRESIDENT) | ||||||||||||||||||||||||
| Entity | Organization | ||||||||||||||||||||||||
| Organization subpart 1 | No | ||||||||||||||||||||||||
| Enumeration date | 12/19/2007 | ||||||||||||||||||||||||
| Last updated | 08/04/2016 - About 10 years ago | ||||||||||||||||||||||||
| Identifiers |
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MICHAEL L BOBO DDS MD PSC
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