Provider Demographics
NPI:1770751570
Name:MOOSE, BOBBI MICHELLE (DDS, MPH)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:MICHELLE
Last Name:MOOSE
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BALTIMORE ST STE 302
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3066
Mailing Address - Country:US
Mailing Address - Phone:301-724-0595
Mailing Address - Fax:
Practice Address - Street 1:12503 WILLOWBROOK RD. SE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-759-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist