Provider Demographics
NPI:1023203197
Name:JOBOULIAN, JOHN ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEXANDER
Last Name:JOBOULIAN
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 1:10522 E BOYER RD
Mailing Address - Street 2:P.O. BOX 5000
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-9757
Mailing Address - Country:US
Mailing Address - Phone:989-584-3941
Mailing Address - Fax:989-584-6202
Practice Address - Street 1:10522 E BOYER RD
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-9757
Practice Address - Country:US
Practice Address - Phone:989-584-3941
Practice Address - Fax:989-584-6202
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist