Provider Demographics
NPI:1487612750
Name:SOBERAY, ANNELLE HALE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNELLE
Middle Name:HALE
Last Name:SOBERAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6203 DELL RD
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-1122
Mailing Address - Country:US
Mailing Address - Phone:952-937-5977
Mailing Address - Fax:952-487-1475
Practice Address - Street 1:6203 DELL RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-1122
Practice Address - Country:US
Practice Address - Phone:952-937-5977
Practice Address - Fax:952-487-1475
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND96741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice