Provider Demographics
NPI:1740367119
Name:BOBO-MESILAS, EDLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:EDLEY
Middle Name:
Last Name:BOBO-MESILAS
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 1:107 DANZIG PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-4813
Mailing Address - Country:US
Mailing Address - Phone:516-285-6161
Mailing Address - Fax:
Practice Address - Street 1:754 E 151ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3267
Practice Address - Country:US
Practice Address - Phone:718-402-2800
Practice Address - Fax:718-993-4395
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049420-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist