Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 11493 | MI |
NPI | 1063575603 |
---|---|
Provider Name | Dr. John H Kobs III |
First Address | Holland, MI 49423-6938 |
Second Address | Holland, MI 49423-6938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 08/07/2007 |