Provider Demographics
NPI:1598495699
Name:VANNASANE, BOBBEE (DDS)
Entity Type:Individual
Prefix:
First Name:BOBBEE
Middle Name:
Last Name:VANNASANE
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 1:1628 MEMORIAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-3596
Mailing Address - Country:US
Mailing Address - Phone:336-226-5485
Mailing Address - Fax:
Practice Address - Street 1:1628 MEMORIAL DR STE B
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-3596
Practice Address - Country:US
Practice Address - Phone:336-226-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC127741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice