Organization
MICHAEL L BOBO DDS MD PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL L BOBO DDS., MD. (OWNER/PRESIDENT)
(270) 759-4063
Entity
Organization
Contact information
Practice address
1109 POPLAR ST, MURRAY, KY 42071-2360
(270) 759-4063
(270) 759-4920
Mailing address
1109 POPLAR ST, MURRAY, KY 42071-2360
(270) 759-4063
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
7404
TN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
7465
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
30866
TN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
34759
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518748
—
TN
05
—
65934655
—
KY
Enumeration date
12/19/2007
Last updated
08/04/2016
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