Healthcare Provider Details

I. General information

NPI: 1427971522
Provider Name (Legal Business Name): THOMAS KOBY-HERCSKY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 SOLANA RD
PONTE VEDRA BEACH FL
32082-2297
US

IV. Provider business mailing address

918 MACON DR
TITUSVILLE FL
32780-4936
US

V. Phone/Fax

Practice location:
  • Phone: 904-280-1717
  • Fax: 904-280-1525
Mailing address:
  • Phone: 305-878-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32149
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: