MEDICARE: DR. R BRUCE KOBS 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	7039	MN

General Provider Information

NPI Number	:	1790857449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. R BRUCE KOBS DDS

Provider Business Mailing Address
First Line	:	4045 BROOKSIDE AVE
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-2808
Country	:	US
Telephone Number	:	952-924-0709
Fax Number	:	952-924-0709

Provider Business Practice Location Address
First Line	:	4045 BROOKSIDE AVE
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-2808
Country	:	US
Telephone Number	:	952-924-0709
Fax Number	:	952-924-0709

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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