Provider Demographics
NPI:1649335241
Name:OBOH, PHILOMENA O (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILOMENA
Middle Name:O
Last Name:OBOH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7136 HASKELL AVE STE 217
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4112
Mailing Address - Country:US
Mailing Address - Phone:818-781-5180
Mailing Address - Fax:818-781-5180
Practice Address - Street 1:7136 HASKELL AVE STE 217
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4112
Practice Address - Country:US
Practice Address - Phone:818-781-5180
Practice Address - Fax:818-781-5180
Is Sole Proprietor?:No
Enumeration Date:2006-12-25
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41121OtherLICENSE