Provider Demographics
NPI:1780773655
Name:BOBEVA, MICHAELA (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:
Last Name:BOBEVA
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15419 NE 20TH ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3800
Mailing Address - Country:US
Mailing Address - Phone:425-747-0144
Mailing Address - Fax:425-747-1413
Practice Address - Street 1:15419 NE 20TH ST
Practice Address - Street 2:SUITE #101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3800
Practice Address - Country:US
Practice Address - Phone:425-747-0144
Practice Address - Fax:425-747-1413
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000099911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice