Provider Demographics
NPI:1962708016
Name:DOBSON, MICHAEL JARED (DMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JARED
Last Name:DOBSON
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 1:4334 ALTIVO LN
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-7329
Mailing Address - Country:US
Mailing Address - Phone:951-277-7477
Mailing Address - Fax:
Practice Address - Street 1:720 MAGNOLIA AVE
Practice Address - Street 2:SUITE A3
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3119
Practice Address - Country:US
Practice Address - Phone:951-371-2142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA568851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice