Provider Demographics
NPI:1740253806
Name:TOBIAS, LUZ DEPANTE (DDS)
Entity type:Individual
Prefix:DR
First Name:LUZ
Middle Name:DEPANTE
Last Name:TOBIAS
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 1:303 E BASELINE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6575
Mailing Address - Country:US
Mailing Address - Phone:602-276-1995
Mailing Address - Fax:602-276-1918
Practice Address - Street 1:303 E BASELINE RD STE 201
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6575
Practice Address - Country:US
Practice Address - Phone:602-276-1995
Practice Address - Fax:602-276-1918
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ559809Medicaid