Provider Demographics
NPI:1760580781
Name:COBB, PATRICK J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:COBB
Suffix:
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 1:516 COST AVE
Mailing Address - Street 2:
Mailing Address - City:STONEWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4811
Mailing Address - Country:US
Mailing Address - Phone:304-624-5250
Mailing Address - Fax:304-624-5251
Practice Address - Street 1:930 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1673
Practice Address - Country:US
Practice Address - Phone:304-842-7568
Practice Address - Fax:304-842-2202
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV36421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001855OtherWV DENTAL MEDICAL CARD