Provider Demographics
NPI:1558514117
Name:KOBE, ELISE RENEE' (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:RENEE'
Last Name:KOBE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 N ROCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1507
Mailing Address - Country:US
Mailing Address - Phone:402-490-9179
Mailing Address - Fax:
Practice Address - Street 1:4607 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2749
Practice Address - Country:US
Practice Address - Phone:314-481-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008030589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist