Provider Demographics
NPI:1023626298
Name:COBB, KRYSTINA (DDS)
Entity type:Individual
Prefix:DR
First Name:KRYSTINA
Middle Name:
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 1:536 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47842-2320
Mailing Address - Country:US
Mailing Address - Phone:812-239-2102
Mailing Address - Fax:
Practice Address - Street 1:1626 S STATE ROAD 46
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-9301
Practice Address - Country:US
Practice Address - Phone:812-645-1195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013368A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist