Provider Demographics
NPI:1649469214
Name:GOBETTI, JOHN PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:GOBETTI
Suffix:
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 1:169 BARTON DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1142
Mailing Address - Country:US
Mailing Address - Phone:734-663-3651
Mailing Address - Fax:734-668-2089
Practice Address - Street 1:169 BARTON DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1142
Practice Address - Country:US
Practice Address - Phone:734-663-3651
Practice Address - Fax:734-668-2089
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901009411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist