Provider Demographics
NPI:1629153945
Name:COBB, DONALD DEAN JR (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:DEAN
Last Name:COBB
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-4539
Mailing Address - Country:US
Mailing Address - Phone:501-565-1574
Mailing Address - Fax:501-565-6825
Practice Address - Street 1:6600 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4539
Practice Address - Country:US
Practice Address - Phone:501-565-1574
Practice Address - Fax:501-565-6825
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice