Healthcare Provider Details

I. General information

NPI: 1578756151
Provider Name (Legal Business Name): DAVID CLARK HOBSON DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 MINNIE ST SUITE B
FAIRBANKS AK
99701-3000
US

IV. Provider business mailing address

114 MINNIE ST STE B
FAIRBANKS AK
99701-3000
US

V. Phone/Fax

Practice location:
  • Phone: 907-457-7878
  • Fax: 907-457-4509
Mailing address:
  • Phone: 907-457-7878
  • Fax: 907-457-4509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1533
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: