Provider Demographics
NPI:1841782406
Name:VIDYA BOBBA DENTAL GROUP INC.
Entity type:Organization
Organization Name:VIDYA BOBBA DENTAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VIDYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBBA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-578-8331
Mailing Address - Street 1:393 BLOSSOM HILL RD STE 330
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:393 BLOSSOM HILL RD STE 330
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1659
Practice Address - Country:US
Practice Address - Phone:408-578-8331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty