Provider Demographics
NPI:1013223999
Name:BOBBA, PRASANTHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRASANTHI
Middle Name:
Last Name:BOBBA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 W SHERMAN AVE STE 4D
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6911
Mailing Address - Country:US
Mailing Address - Phone:856-368-2800
Mailing Address - Fax:856-412-5100
Practice Address - Street 1:1206 W SHERMAN AVE STE 4D
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6911
Practice Address - Country:US
Practice Address - Phone:856-368-2800
Practice Address - Fax:856-412-5100
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024577001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry