Healthcare Provider Details

I. General information

NPI: 1588656011
Provider Name (Legal Business Name): KARL R JOBST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E 18TH ST
GROVE OK
74344-3237
US

IV. Provider business mailing address

119 E 18TH ST
GROVE OK
74344-3237
US

V. Phone/Fax

Practice location:
  • Phone: 918-787-5800
  • Fax: 918-787-5788
Mailing address:
  • Phone: 918-787-5800
  • Fax: 918-787-5788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5398
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: