Provider Demographics
NPI:1447552047
Name:BOBBERA, MATTHEW LOUIS (DDS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LOUIS
Last Name:BOBBERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 PROSPERITY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4700
Mailing Address - Country:US
Mailing Address - Phone:304-692-1822
Mailing Address - Fax:
Practice Address - Street 1:306 PROSPERITY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4700
Practice Address - Country:US
Practice Address - Phone:865-769-0886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39231223G0001X
TN98901223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice