Provider Demographics
NPI:1902128390
Name:KOBAYASHI, ROXANNE N (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:N
Last Name:KOBAYASHI
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 1:1 CIVIC CENTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2934
Mailing Address - Country:US
Mailing Address - Phone:760-752-1430
Mailing Address - Fax:760-752-1598
Practice Address - Street 1:1 CIVIC CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2934
Practice Address - Country:US
Practice Address - Phone:760-752-1430
Practice Address - Fax:760-752-1598
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374361223G0001X
HIDT-14731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice