Provider Demographics
NPI:1265599351
Name:DOBY, WANDA CHERITA (DDS)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:CHERITA
Last Name:DOBY
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 1:304 LILLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3130
Mailing Address - Country:US
Mailing Address - Phone:704-342-9497
Mailing Address - Fax:704-342-9498
Practice Address - Street 1:304 LILLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3130
Practice Address - Country:US
Practice Address - Phone:704-342-9497
Practice Address - Fax:704-342-9498
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902R4Medicaid