Provider Demographics
NPI:1982816484
Name:SOBOTA, JENNIFER ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:SOBOTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LAKE MARINA AVE APT 4BE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1677
Mailing Address - Country:US
Mailing Address - Phone:248-918-9827
Mailing Address - Fax:
Practice Address - Street 1:2901 N CAUSEWAY BLVD
Practice Address - Street 2:METAIRIE VA DENTAL CLINIC
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4824
Practice Address - Country:US
Practice Address - Phone:504-565-4748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010192731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice