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NPI Code Detail

MEDICARE: DR. PAULA TOBAR DDS

MEDICARE: DR. PAULA TOBAR DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2901601146MI

General Provider Information

NPI Number : 1710659636
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAULA TOBAR DDS
Provider Business Mailing Address
First Line : 3374 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48207-4236
Country : US
Telephone Number : 313-259-2410
Fax Number :
Provider Business Practice Location Address
First Line : 3374 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48207-4236
Country : US
Telephone Number : 313-259-2410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2021
Last Update Date : 06/07/2024

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