Provider Demographics
NPI:1164727889
Name:BOBBIO, JENNIFER CECIL (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CECIL
Last Name:BOBBIO
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 1:42206 BUNKER WOODS PL
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6434
Mailing Address - Country:US
Mailing Address - Phone:703-402-0281
Mailing Address - Fax:
Practice Address - Street 1:1515 WILSON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2402
Practice Address - Country:US
Practice Address - Phone:703-528-3336
Practice Address - Fax:703-524-2206
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014131291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAFB2723597OtherDEA