Provider Demographics
NPI:1225277999
Name:COBB DENTAL CORPORATION
Entity Type:Organization
Organization Name:COBB DENTAL CORPORATION
Other - Org Name:COBB DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-753-2361
Mailing Address - Street 1:600 W. MANCHESTER AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044
Mailing Address - Country:US
Mailing Address - Phone:323-753-2361
Mailing Address - Fax:323-753-0313
Practice Address - Street 1:600 W MANCHESTER AVE STE 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-5700
Practice Address - Country:US
Practice Address - Phone:323-753-2361
Practice Address - Fax:323-753-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty