Provider Demographics
NPI:1891787057
Name:COBB, KRISTI L (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:L
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:P O BOX 1428
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-1428
Mailing Address - Country:US
Mailing Address - Phone:405-376-1027
Mailing Address - Fax:405-376-1036
Practice Address - Street 1:1108 N MUSTANG RD
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-1428
Practice Address - Country:US
Practice Address - Phone:405-376-1027
Practice Address - Fax:405-376-1036
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice