Provider Demographics
NPI:1669505707
Name:TOBIAS, GERALD B (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:B
Last Name:TOBIAS
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 1:5300 S. ADAMS AVE. PARKWAY
Mailing Address - Street 2:SUITE 15
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405
Mailing Address - Country:US
Mailing Address - Phone:801-479-7600
Mailing Address - Fax:801-479-7600
Practice Address - Street 1:5300 S. ADAMS AVE. PARKWAY
Practice Address - Street 2:SUITE 15
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-479-7600
Practice Address - Fax:801-479-7600
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1372981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice