Healthcare Provider Details

I. General information

NPI: 1285293712
Provider Name (Legal Business Name): LAUREN KOBOLD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 E STATE ST
FARMINGTON UT
84025-2343
US

IV. Provider business mailing address

15101 REDGATE DR
SILVER SPRING MD
20905-5730
US

V. Phone/Fax

Practice location:
  • Phone: 801-451-2341
  • Fax:
Mailing address:
  • Phone: 801-661-6087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11322714-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: