Healthcare Provider Details

I. General information

NPI: 1215909155
Provider Name (Legal Business Name): GLORIA HOBAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 78 BOX 107
APO AP
96326
JP

IV. Provider business mailing address

PSC 78 BOX 107
APO AP
96326
JP

V. Phone/Fax

Practice location:
  • Phone: 402-752-3448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4387
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: