Provider Demographics
NPI:1134309123
Name:PATRICK L DOBASH DDS PC
Entity Type:Organization
Organization Name:PATRICK L DOBASH DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:DOBASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-974-0500
Mailing Address - Street 1:13943 N 91ST AVE
Mailing Address - Street 2:SUITE H-102
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3689
Mailing Address - Country:US
Mailing Address - Phone:623-974-0500
Mailing Address - Fax:623-974-2212
Practice Address - Street 1:13943 N 91ST AVE
Practice Address - Street 2:SUITE H-102
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3689
Practice Address - Country:US
Practice Address - Phone:623-974-0500
Practice Address - Fax:623-974-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty