Provider Demographics
NPI:1407367550
Name:HOBART, CODEE L (LD-)
Entity Type:Individual
Prefix:MRS
First Name:CODEE
Middle Name:L
Last Name:HOBART
Suffix:
Gender:F
Credentials:LD-
Other - Prefix:MS
Other - First Name:CODEE
Other - Middle Name:L
Other - Last Name:SHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1850 WILLIAMS HWY
Mailing Address - Street 2:ROGUE RIVER DENTURE SERVICE
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527
Mailing Address - Country:US
Mailing Address - Phone:541-476-0254
Mailing Address - Fax:547-955-7277
Practice Address - Street 1:1850 WILLIAMS HWY
Practice Address - Street 2:ROGUE RIVER DENTURE SERVICE
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527
Practice Address - Country:US
Practice Address - Phone:541-476-0254
Practice Address - Fax:541-955-7277
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO-10180873122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist