Provider Demographics
NPI:1407064280
Name:DON, BOBBY S (DDS)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:S
Last Name:DON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:S
Other - Last Name:DON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:62 CORPORATE PARK
Mailing Address - Street 2:SUITE 230
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-3122
Mailing Address - Country:US
Mailing Address - Phone:949-222-0296
Mailing Address - Fax:949-222-1110
Practice Address - Street 1:62 CORPORATE PARK
Practice Address - Street 2:SUITE 230
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-3122
Practice Address - Country:US
Practice Address - Phone:949-222-0296
Practice Address - Fax:949-222-1110
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice