Provider Demographics
NPI:1033237631
Name:HOBAN, PATRICK JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:HOBAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PATRICK
Other - Middle Name:JOSEPH
Other - Last Name:HOBAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5184 WINTON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2900
Mailing Address - Country:US
Mailing Address - Phone:513-858-1600
Mailing Address - Fax:513-858-2012
Practice Address - Street 1:5184 WINTON RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2900
Practice Address - Country:US
Practice Address - Phone:513-858-1600
Practice Address - Fax:513-858-2012
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300177971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH608926Medicaid