Provider Demographics
NPI:1982136693
Name:KOBAR, MARISA A (RDH,BS)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:A
Last Name:KOBAR
Suffix:
Gender:F
Credentials:RDH,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W SHERRI DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7933
Mailing Address - Country:US
Mailing Address - Phone:602-625-5648
Mailing Address - Fax:
Practice Address - Street 1:901 W SHERRI DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-7933
Practice Address - Country:US
Practice Address - Phone:602-625-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH02082124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist