Provider Demographics
NPI:1376685768
Name:SOBBA-WORRELL, MICHELLE LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:SOBBA-WORRELL
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 1:9319 E HARRY ST STE 124
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5070
Mailing Address - Country:US
Mailing Address - Phone:316-685-0293
Mailing Address - Fax:316-685-0294
Practice Address - Street 1:9319 E HARRY ST STE 124
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5070
Practice Address - Country:US
Practice Address - Phone:316-685-0293
Practice Address - Fax:316-685-0294
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS604001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice