MEDICARE: DR. STEVEN C CHOBOT DDS

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	1223G0001X	General Practice Dentistry	7138	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104886	OTHER	WA	DEPT. OF LABOR AND INDUST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	57138	OTHER	WA	WASHINGTON DENTAL SERVICE
4	803154	OTHER	WA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1841419777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN C CHOBOT DDS

Provider Business Mailing Address
First Line	:	1590 WOODRIDGE DR SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3818
Country	:	US
Telephone Number	:	360-871-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1590 WOODRIDGE DR SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3818
Country	:	US
Telephone Number	:	360-871-5100
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/09/2007

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