Provider Demographics
NPI:1093951865
Name:TOBIAS, ALICE CHABORA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:CHABORA
Last Name:TOBIAS
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 1:2819 214TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2642
Mailing Address - Country:US
Mailing Address - Phone:347-351-4506
Mailing Address - Fax:
Practice Address - Street 1:2819 214TH ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2642
Practice Address - Country:US
Practice Address - Phone:347-351-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0337491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics