Healthcare Provider Details

I. General information

NPI: 1841728839
Provider Name (Legal Business Name): JULIO E OBANDO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 WYCLIFF AVE
DALLAS TX
75219-2551
US

IV. Provider business mailing address

2525 WYCLIFF AVE
DALLAS TX
75219-2551
US

V. Phone/Fax

Practice location:
  • Phone: 214-219-3719
  • Fax:
Mailing address:
  • Phone: 312-415-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901022167
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number35867
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: