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General NPI Number Information
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NPI Number | 1063466977
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Entity Type | Individual
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Provider Name | BOBBY LEE RABER DDM
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Gender | Male
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2801 N PLEASANT VIEW DR.
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314
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Country | US
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Telephone | 928-443-1400
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Fax | 928-777-8264
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Provider Business Mailing Address
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Address Line | 2801 N PLEASANT VIEW DR.
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314
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Country | US
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Telephone | 215-520-2032
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Fax | 928-777-8264
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 6860
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License Number State | AZ
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