Healthcare Provider Details

I. General information

NPI: 1255987616
Provider Name (Legal Business Name): KATELYN NOELLE BOBBITT DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 LUISA ST STE 1
SANTA FE NM
87505-4161
US

IV. Provider business mailing address

6931 WALNUT CREEK RD NE
ALBUQUERQUE NM
87109-2833
US

V. Phone/Fax

Practice location:
  • Phone: 505-303-4503
  • Fax:
Mailing address:
  • Phone: 479-806-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD5180
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: