Provider Demographics
NPI:1770992901
Name:RICHARD COBA DMD PA
Entity type:Organization
Organization Name:RICHARD COBA DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:IGNACIO
Authorized Official - Last Name:COBA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-903-7800
Mailing Address - Street 1:9541 SW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3247
Mailing Address - Country:US
Mailing Address - Phone:305-595-1239
Mailing Address - Fax:305-595-1241
Practice Address - Street 1:9541 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3247
Practice Address - Country:US
Practice Address - Phone:305-595-1239
Practice Address - Fax:305-595-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty