Provider Demographics
NPI:1508653130
Name:BOBBA, CHARAN TEJA (DDS)
Entity type:Individual
Prefix:
First Name:CHARAN TEJA
Middle Name:
Last Name:BOBBA
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 TEHAMA ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4147
Mailing Address - Country:US
Mailing Address - Phone:201-856-1002
Mailing Address - Fax:
Practice Address - Street 1:45 DODGE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1705
Practice Address - Country:US
Practice Address - Phone:978-288-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000000001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice