Individual provider Active NPI

John H Kobs III, DDS MS

  • Periodontics
  • Holland, MI
National Provider Identifier
1063575603
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
11493 Issued in MI
Practice address
203 West 30TH Street
Holland, MI 49423-6938
Phone
(616) 392-1477
Fax
(616) 392-4463
NPI assigned
Dec 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 11493 MI Primary

Addresses

Primary practice location

203 West 30TH Street
Holland, MI 49423-6938

Mailing address

203 West 30TH Street
Holland, MI 49423-6938
Phone (616) 392-1477

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151124001523 MI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 8729388756

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063575603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 WEST 30TH STREET",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494236938",
            "telephone_number": "616-392-1477",
            "fax_number": "616-392-4463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 WEST 30TH STREET",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494236938",
            "telephone_number": "616-392-1477",
            "fax_number": "616-392-4463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOBS",
        "first_name": "JOHN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "11493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

Verify at the official NPI Registry.