Jonathan Koby – Dentist in Oconto, WI

Key facts

NPI: 1720873458
Entity type: Individual (NPI type 1)
Primary specialty: Dentist 122300000X
License: 6001805 (WI)
Practice address: 155 Memorial Dr
Oconto, WI 54153-2053
Phone: (920) 516-7107
NPI assigned: Apr 12, 2025
Sex: Male
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

The Lakes Community Health Center, Inc Federally Qualified Health Center (FQHC) · Marinette, WI · NPI 1518690841

NPD (past)
The Lakes Community Health Center, Inc Federally Qualified Health Center (FQHC) · White Lake, WI · NPI 1679983423

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
6001805	WI	MD	Dentist

Practice roles

Organization	Specialty	Status	New patients
The Lakes Community Health Center, Inc		Past since Jul 1, 2022	Accepting new patients
The Lakes Community Health Center, Inc		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist	122300000X	6001805	WI	Yes

Addresses

Primary practice location

155 Memorial Dr
Oconto, WI 54153-2053

Mailing address

2729 Richard St
Marinette, WI 54143-4117
Phone (920) 370-0064

Other practice location 1

1435 Cleveland Ave
Marinette, WI 54143-3918
Phone (715) 504-6419

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 26, 2025.

{
    "created_epoch": "1744416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756166400000",
    "number": "1720873458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2729 RICHARD ST",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541434117",
            "telephone_number": "920-370-0064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 MEMORIAL DR",
            "city": "OCONTO",
            "state": "WI",
            "postal_code": "541532053",
            "telephone_number": "920-516-7107"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1435 Cleveland Ave",
            "address_purpose": "LOCATION",
            "city": "Marinette",
            "state": "WI",
            "postal_code": "541433918",
            "country_code": "US",
            "telephone_number": "715-504-6419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOBY",
        "first_name": "JONATHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-12",
        "last_updated": "2025-08-26",
        "certification_date": "2025-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6001805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oconto, WI

All providers in Oconto, WI · Dentist in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2025. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.