Provider Demographics
NPI:1053775783
Name:MCBRIDE, BOBBY EUGENE (DDS)
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:EUGENE
Last Name:MCBRIDE
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 1:156 BIRDSONG TRL
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-9301
Mailing Address - Country:US
Mailing Address - Phone:803-960-6574
Mailing Address - Fax:
Practice Address - Street 1:156 BIRDSONG TRL
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-9301
Practice Address - Country:US
Practice Address - Phone:803-960-6574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist