Provider Demographics
NPI:1063691780
Name:BOBBETT, CAROLINE A (DDS, MAGD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:A
Last Name:BOBBETT
Suffix:
Gender:F
Credentials:DDS, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8540 S EASTERN AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2834
Mailing Address - Country:US
Mailing Address - Phone:702-457-6787
Mailing Address - Fax:702-457-3557
Practice Address - Street 1:8540 S EASTERN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2834
Practice Address - Country:US
Practice Address - Phone:702-457-6787
Practice Address - Fax:702-457-3557
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS346721223G0001X
NV23511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2202147Medicaid