Individual
DR. ROBERT WARREN KOUBSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3400 1ST ST N, #102, ST CLOUD, MN 56303
(320) 255-9048
(320) 251-4745
Mailing address
3400 1ST ST N, #102, ST CLOUD, MN 56303
(320) 255-9048
(320) 251-4745
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
MN 8778
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4347273
MN STATE TAX ID
MN
Enumeration date
09/21/2006
Last updated
07/08/2007
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