MEDICARE: DR. MICHAEL WILLIAM COBB DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30-020375	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30-020375	OTHER	OH	STATE LICENSE

General Provider Information

NPI Number	:	1659562510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL WILLIAM COBB DDS

Provider Business Mailing Address
First Line	:	1642 RALSTON CIR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-3801
Country	:	US
Telephone Number	:	419-536-7265
Fax Number	:	419-724-1651

Provider Business Practice Location Address
First Line	:	1642 RALSTON CIR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-3801
Country	:	US
Telephone Number	:	419-536-7265
Fax Number	:	419-724-1651

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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