Healthcare Provider Details

I. General information

NPI: 1689282089
Provider Name (Legal Business Name): NATHAN ELMER KOBOLD DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 N SARATOGA ST
OAK HARBOR WA
98278-4927
US

IV. Provider business mailing address

1031 COVE VIEW CIR
OAK HARBOR WA
98277-8257
US

V. Phone/Fax

Practice location:
  • Phone: 360-257-9413
  • Fax:
Mailing address:
  • Phone: 406-672-4529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number11837216-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: