Provider Demographics
NPI:1821139361
Name:TOBIN, GARY PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:PAUL
Last Name:TOBIN
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 1:16055 VENTURA BLVD STE 1035
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2629
Mailing Address - Country:US
Mailing Address - Phone:818-990-5240
Mailing Address - Fax:818-990-2641
Practice Address - Street 1:16055 VENTURA BLVD STE 1035
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2629
Practice Address - Country:US
Practice Address - Phone:818-990-5240
Practice Address - Fax:818-990-2641
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0355591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice