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General NPI Number Information
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NPI Number | 1396509675
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Entity Type | Individual
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Provider Name | THOMAS JAY KOBITTER DDS
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Gender | Male
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 8568 SW APPLE WAY
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City | PORTLAND
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State | OR
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Zip | 97225-1772
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Country | US
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Telephone | 503-292-6773
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Fax |
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Provider Business Mailing Address
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Address Line | 140 SW COLUMBIA ST APT 1402
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City | PORTLAND
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State | OR
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Zip | 97201-5887
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Country | US
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Telephone | 224-456-9831
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D12205
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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