Provider Demographics
NPI:1861537805
Name:BOBBITT, TILDEN DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TILDEN
Middle Name:DEAN
Last Name:BOBBITT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 DUDLEY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-2105
Mailing Address - Country:US
Mailing Address - Phone:304-428-2800
Mailing Address - Fax:
Practice Address - Street 1:2801 DUDLEY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2105
Practice Address - Country:US
Practice Address - Phone:304-428-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-02-09741223S0112X
WV3409-1051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV8000003000Medicaid
WV8000003000Medicaid