Healthcare Provider Details
I. General information
NPI: 1467829408
Provider Name (Legal Business Name): HOBSON ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/25/2015
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1700 12TH ST SUITE D
HOOD RIVER OR
97031-9540
US
IV. Provider business mailing address
1700 12TH ST SUITE D
HOOD RIVER OR
97031-9540
US
V. Phone/Fax
- Phone: 971-404-4699
- Fax:
- Phone: 971-404-4699
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1223X0400X |
| Taxonomy | Orthodontics and Dentofacial Orthopedics Dentistry |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
KARA
A
HOBSON
Title or Position: OWNER
Credential: DDS
Phone: 971-404-4699