Provider Demographics
NPI:1689888000
Name:COBB, REGINA ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:ELIZABETH
Last Name:COBB
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 1:1111 RIATA VALLEY RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3678
Mailing Address - Country:US
Mailing Address - Phone:928-757-9190
Mailing Address - Fax:928-757-1079
Practice Address - Street 1:1111 RIATA VALLEY RD
Practice Address - Street 2:SUITE 350
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3678
Practice Address - Country:US
Practice Address - Phone:928-757-9190
Practice Address - Fax:928-757-1079
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist