Provider Demographics
NPI:1225585516
Name:REPP, BOBBIE LYNN (RDH)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:LYNN
Last Name:REPP
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6709 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5220
Mailing Address - Country:US
Mailing Address - Phone:480-296-4723
Mailing Address - Fax:
Practice Address - Street 1:6709 E 3RD ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5220
Practice Address - Country:US
Practice Address - Phone:480-296-4723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH06621124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist