Healthcare Provider Details

I. General information

NPI: 1396509675
Provider Name (Legal Business Name): THOMAS JAY KOBITTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8568 SW APPLE WAY
PORTLAND OR
97225-1772
US

IV. Provider business mailing address

140 SW COLUMBIA ST APT 1402
PORTLAND OR
97201-5887
US

V. Phone/Fax

Practice location:
  • Phone: 503-292-6773
  • Fax:
Mailing address:
  • Phone: 224-456-9831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12205
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: