Provider Demographics
NPI:1942669429
Name:TOBON, JAIME (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:TOBON
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 1:9276 W UNION HILLS DR STE A
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8206
Mailing Address - Country:US
Mailing Address - Phone:623-566-1200
Mailing Address - Fax:
Practice Address - Street 1:9276 W UNION HILLS DR STE A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8206
Practice Address - Country:US
Practice Address - Phone:623-566-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009413122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program