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Individual

DR. MICHAEL LEE BOBO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS MD

Contact information

Practice address
1109 POPLAR STREET, MURRAY, KY 42071
(270) 759-4063
(270) 759-4920
Mailing address
1109 POPLAR STREET, MURRAY, KY 42071
(270) 759-4063
(270) 759-4920

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
34759
KY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7465 DENTAL
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
34759
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
60000163
KY
05
64011711
KY
Enumeration date
10/25/2006
Last updated
07/12/2012
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