Provider Demographics
NPI:1215039441
Name:COBER, DAN D (DMD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:D
Last Name:COBER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32310-4348
Mailing Address - Country:US
Mailing Address - Phone:941-861-2640
Mailing Address - Fax:941-861-2868
Practice Address - Street 1:912 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32310-4348
Practice Address - Country:US
Practice Address - Phone:941-861-2640
Practice Address - Fax:941-861-2868
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN84881223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0727393-00Medicaid