Provider Demographics
NPI:1194885061
Name:DOBBERSTEIN, JOHN A (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:DOBBERSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 LANGFORD DR
Mailing Address - Street 2:BLDG 200, SUITE 103
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2542
Mailing Address - Country:US
Mailing Address - Phone:706-395-0079
Mailing Address - Fax:
Practice Address - Street 1:1181 LANGFORD DR
Practice Address - Street 2:BLDG 200, SUITE 103
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2542
Practice Address - Country:US
Practice Address - Phone:706-395-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0113221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice