Provider Demographics
NPI:1386842243
Name:OBEDA, PAUL L (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:OBEDA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2307
Mailing Address - Country:US
Mailing Address - Phone:856-783-2093
Mailing Address - Fax:856-783-2644
Practice Address - Street 1:614 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-2307
Practice Address - Country:US
Practice Address - Phone:856-783-2093
Practice Address - Fax:856-783-2644
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1009631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist