Provider Demographics
NPI:1497303267
Name:TOBON, JAIME ARTURO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:ARTURO
Last Name:TOBON
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 1:1263 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2233
Mailing Address - Country:US
Mailing Address - Phone:559-556-6082
Mailing Address - Fax:559-556-6166
Practice Address - Street 1:1263 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2233
Practice Address - Country:US
Practice Address - Phone:559-556-6082
Practice Address - Fax:559-556-6166
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63324122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist