Provider Demographics
NPI:1912082959
Name:COBBINS, PRESTON L (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:L
Last Name:COBBINS
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 1:1863 HIGHWAY 43 S
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-8877
Mailing Address - Country:US
Mailing Address - Phone:601-859-7050
Mailing Address - Fax:601-859-7062
Practice Address - Street 1:1863 HIGHWAY 43 S
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-8877
Practice Address - Country:US
Practice Address - Phone:601-859-7050
Practice Address - Fax:601-859-7062
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS30621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016094Medicaid