Provider Demographics
NPI:1619376993
Name:PHILOMENA O OBOH DDS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PHILOMENA O OBOH DDS A PROFESSIONAL CORPORATION
Other - Org Name:GLOBAL DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILOMENA
Authorized Official - Middle Name:O
Authorized Official - Last Name:OBOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-781-5180
Mailing Address - Street 1:14434 HAMLIN STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1461
Mailing Address - Country:US
Mailing Address - Phone:818-781-5180
Mailing Address - Fax:818-781-4651
Practice Address - Street 1:7136 HASKELL AVE STE 217
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4112
Practice Address - Country:US
Practice Address - Phone:818-781-5180
Practice Address - Fax:818-787-0655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHILOMENA O OBOH DDS A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-22
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB204573OtherPTAN