Provider Demographics
NPI:1336414341
Name:TOBIAS, SIDNEY JAMES JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:JAMES
Last Name:TOBIAS
Suffix:JR
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:PO BOX 2770
Mailing Address - Street 2:
Mailing Address - City:RESERVE
Mailing Address - State:LA
Mailing Address - Zip Code:70084-2770
Mailing Address - Country:US
Mailing Address - Phone:985-359-7639
Mailing Address - Fax:985-652-1779
Practice Address - Street 1:1126 W AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3717
Practice Address - Country:US
Practice Address - Phone:985-359-7639
Practice Address - Fax:985-652-1779
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3640122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice