Healthcare Provider Details

I. General information

NPI: 1619098720
Provider Name (Legal Business Name): BRIAN J KOBITTER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 STATE ROAD 52
HUDSON FL
34667-6713
US

IV. Provider business mailing address

7400 STATE ROAD 52
HUDSON FL
34667-6713
US

V. Phone/Fax

Practice location:
  • Phone: 727-862-5225
  • Fax: 727-868-5555
Mailing address:
  • Phone: 727-862-5225
  • Fax: 727-868-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10326
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: