Provider Demographics
NPI:1558387241
Name:ALLADA, SOBHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOBHA
Middle Name:
Last Name:ALLADA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15401 ANACAPA RD STE 3
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2466
Mailing Address - Country:US
Mailing Address - Phone:760-951-9304
Mailing Address - Fax:760-951-9384
Practice Address - Street 1:15401 ANACAPA RD STE 3
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2466
Practice Address - Country:US
Practice Address - Phone:760-951-9304
Practice Address - Fax:760-951-9384
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice