Healthcare Provider Details

I. General information

NPI: 1477799351
Provider Name (Legal Business Name): ALEX KOBB, D.D.S., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2008
Last Update Date: 12/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 PINEWALK DR N #106
MARGATE FL
33063-7823
US

IV. Provider business mailing address

3405 PINEWALK DR N #106
MARGATE FL
33063-7823
US

V. Phone/Fax

Practice location:
  • Phone: 954-755-8232
  • Fax: 954-755-8232
Mailing address:
  • Phone: 954-755-8232
  • Fax: 954-755-8232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberDN3787
License Number StateFL

VIII. Authorized Official

Name: ALEX KOBB
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 954-755-8232