Provider Demographics
NPI:1477633865
Name:BOBIER, GREGG DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:DAVID
Last Name:BOBIER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5577 SAINT ANDREW CIR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4831
Mailing Address - Country:US
Mailing Address - Phone:248-227-8305
Mailing Address - Fax:
Practice Address - Street 1:5838 METRO WAY SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9619
Practice Address - Country:US
Practice Address - Phone:269-966-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI290910137081223S0112X
MI29010137081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
5637022OtherBLUE CROSS
MI10-4473123Medicaid
MI12-4473099Medicaid
5637022OtherBLUE CROSS
MI10-4473123Medicaid