Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 6860 | AZ |
NPI | 1063466977 |
---|---|
Provider Name | Dr. Bobby Lee Raber |
First Address | Prescott Valley, AZ 86314 |
Second Address | Prescott Valley, AZ 86314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 08/07/2007 |