Healthcare Provider Details

I. General information

NPI: 1528440146
Provider Name (Legal Business Name): KENNETH CRAIG HOBBS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 KEILY STREET BUREAU OF MED AND SURG CCPD
JACKSONVILLE FL
32212
US

IV. Provider business mailing address

554 KEILY STREET BUREAU OF MED AND SURG CCPD
JACKSONVILLE FL
32212
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-7011
  • Fax:
Mailing address:
  • Phone: 757-953-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS040402
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: