Mikhail Yurevich Kobakov, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN1857895 Issued in MA

Practice address

2 Jungle Rd
Leominster, MA 01453

Phone

(978) 534-8300

NPI assigned

Apr 9, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Michael Yury Kobakov Professional name

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532908800000",
    "number": "1356784375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 JUNGLE RD",
            "city": "LEOMINSTER",
            "state": "MA",
            "postal_code": "014535208",
            "telephone_number": "978-534-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 JUNGLE RD",
            "city": "LEOMINSTER",
            "state": "MA",
            "postal_code": "01453",
            "telephone_number": "978-534-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOBAKOV",
        "first_name": "MIKHAIL",
        "middle_name": "YUREVICH",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-09",
        "last_updated": "2018-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CT",
            "license": "11809",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MA",
            "license": "DN1857895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAEL",
            "last_name": "KOBAKOV",
            "middle_name": "YURY",
            "credential": "DMD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Michelle Kim
• Soyoung Kim, DMD
• Ana M Kincaid Bruun, LICSW
• Gini Lee King
• Joyce W Kiruki
• Stella Konadu
• Eric C. Kosinski, M.D.
• Susan Anne Kraemer, B.S.
• Elisabeth Kranz, M.S., CCC-SLP
• Kre Leominster Licensee LLC

• Oral and Maxillofacial Surgery (Dentist) in Leominster, MA
• Providers in Leominster, MA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.