Provider Demographics
NPI:1801015441
Name:BOBROW, SCOTT EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDWARD
Last Name:BOBROW
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 1:1 OCEAN BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SOUTHERN SHORES
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3616
Mailing Address - Country:US
Mailing Address - Phone:252-255-1001
Mailing Address - Fax:252-255-1005
Practice Address - Street 1:1 OCEAN BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:SOUTHERN SHORES
Practice Address - State:NC
Practice Address - Zip Code:27949-3616
Practice Address - Country:US
Practice Address - Phone:252-255-1001
Practice Address - Fax:252-255-1005
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7740122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist