MEDICARE: RICHARD COBA DMD PA

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	DN18886	FL

General Provider Information

NPI Number	:	1770992901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD COBA DMD PA

Provider Business Mailing Address
First Line	:	9541 SW 72ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3247
Country	:	US
Telephone Number	:	305-595-1239
Fax Number	:	305-595-1241

Provider Business Practice Location Address
First Line	:	9541 SW 72ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3247
Country	:	US
Telephone Number	:	305-595-1239
Fax Number	:	305-595-1241

Authorized Official
Title or Position	:	GENERAL DENTIST/ PRESIDENT
Name	:	MR. RICHARD IGNACIO COBA
Credential	:	DMD
Telephone Number	:	305-903-7800

Provider Enumeration Date	:	08/13/2014
Last Update Date	:	08/13/2014

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