Provider Demographics
NPI:1265870919
Name:COBB, AMANDA LEONE (DMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEONE
Last Name:COBB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 W GRANADA BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9522
Mailing Address - Country:US
Mailing Address - Phone:386-672-6581
Mailing Address - Fax:
Practice Address - Street 1:29872 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:BIG PINE KEY
Practice Address - State:FL
Practice Address - Zip Code:33043-3313
Practice Address - Country:US
Practice Address - Phone:305-872-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist