Provider Demographics
NPI:1619098720
Name:KOBITTER, BRIAN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:KOBITTER
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 1:7400 STATE ROAD 52
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6713
Mailing Address - Country:US
Mailing Address - Phone:727-862-5225
Mailing Address - Fax:727-868-5555
Practice Address - Street 1:7400 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6713
Practice Address - Country:US
Practice Address - Phone:727-862-5225
Practice Address - Fax:727-868-5555
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice