Provider Demographics
NPI:1215913108
Name:PETRESCU-BOBOC, GEORGE (DDS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:PETRESCU-BOBOC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 1003
Mailing Address - Street 2:BOX 9
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09728
Mailing Address - Country:US
Mailing Address - Phone:011354-425-2168
Mailing Address - Fax:
Practice Address - Street 1:PSC 1003
Practice Address - Street 2:BOX 9
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09728
Practice Address - Country:US
Practice Address - Phone:011354-425-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice