Provider Demographics
NPI:1831160365
Name:CAROLINE A. BOBBETT, DDS APC
Entity type:Organization
Organization Name:CAROLINE A. BOBBETT, DDS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOBBETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-457-6787
Mailing Address - Street 1:8540 S. EASTERN AVENUE
Mailing Address - Street 2:#120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2847
Mailing Address - Country:US
Mailing Address - Phone:702-457-6787
Mailing Address - Fax:702-457-3557
Practice Address - Street 1:8540 S. EASTERN AVENUE
Practice Address - Street 2:#120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2847
Practice Address - Country:US
Practice Address - Phone:702-457-6787
Practice Address - Fax:702-457-3557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2351122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2202147Medicaid