Provider Demographics
NPI:1922291129
Name:SOBOH DENTAL INCORPORATED
Entity Type:Organization
Organization Name:SOBOH DENTAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-622-6633
Mailing Address - Street 1:101 W MISSION BLVD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1711
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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49415261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental