Provider Demographics
NPI:1689706012
Name:SOBOH, AHMED A (DDS)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:A
Last Name:SOBOH
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 1:101 W MISSION BLVD
Mailing Address - Street 2:STE 221
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766
Mailing Address - Country:US
Mailing Address - Phone:909-622-6633
Mailing Address - Fax:909-622-6630
Practice Address - Street 1:101 W MISSION BLVD
Practice Address - Street 2:STE 221
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1711
Practice Address - Country:US
Practice Address - Phone:909-622-6633
Practice Address - Fax:909-622-6630
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice