Provider Demographics
NPI:1174658850
Name:DRS B NOORBAKHSH AND T DEAN BOBBITT PLLC
Entity Type:Organization
Organization Name:DRS B NOORBAKHSH AND T DEAN BOBBITT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TILDEN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BOBBITT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-428-2800
Mailing Address - Street 1:2801 DUDLEY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-2105
Mailing Address - Country:US
Mailing Address - Phone:304-428-2800
Mailing Address - Fax:304-428-5227
Practice Address - Street 1:2801 DUDLEY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2105
Practice Address - Country:US
Practice Address - Phone:304-428-2800
Practice Address - Fax:304-428-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006410Medicaid
WV3810006410Medicaid
=========OtherTAX ID
WV9336701Medicare PIN