MEDICARE: DR. RICHARD IGNACIO COBA D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN18886	FL

General Provider Information

NPI Number	:	1730402595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD IGNACIO COBA D.M.D.

Provider Business Mailing Address
First Line	:	9777 SW 72ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-4615
Country	:	US
Telephone Number	:	306-903-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	9777 SW 72ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-4615
Country	:	US
Telephone Number	:	306-903-7800
Fax Number	:	305-596-1244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	05/07/2013

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