Provider Demographics
NPI:1699902791
Name:BOBBY L. RABER DMD, PLLC
Entity type:Organization
Organization Name:BOBBY L. RABER DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARVA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:928-443-1400
Mailing Address - Street 1:2801 N PLEASANT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-3551
Mailing Address - Country:US
Mailing Address - Phone:928-443-1400
Mailing Address - Fax:928-777-8264
Practice Address - Street 1:2801 N PLEASANT VIEW DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-3551
Practice Address - Country:US
Practice Address - Phone:928-443-1400
Practice Address - Fax:928-777-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty