Provider Demographics
NPI:1790857449
Name:KOBS, R BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:BRUCE
Last Name:KOBS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROGER
Other - Middle Name:BRUCE
Other - Last Name:KOBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4045 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2808
Mailing Address - Country:US
Mailing Address - Phone:952-924-0709
Mailing Address - Fax:952-924-0709
Practice Address - Street 1:4045 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2808
Practice Address - Country:US
Practice Address - Phone:952-924-0709
Practice Address - Fax:952-924-0709
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist