Provider Demographics
NPI:1174534804
Name:COBB, ANDY ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:ALLEN
Last Name:COBB
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 1:612 W COMMERCE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7514
Mailing Address - Country:US
Mailing Address - Phone:501-847-9191
Mailing Address - Fax:501-847-8337
Practice Address - Street 1:612 W COMMERCE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7514
Practice Address - Country:US
Practice Address - Phone:501-847-9191
Practice Address - Fax:501-847-8337
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice