Provider Demographics
NPI:1871918904
Name:KOBLISKA DENTAL CORPORATION
Entity type:Organization
Organization Name:KOBLISKA DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOBLISKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-528-2200
Mailing Address - Street 1:2098 9TH ST
Mailing Address - Street 2:STE. C
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3239
Mailing Address - Country:US
Mailing Address - Phone:805-528-2200
Mailing Address - Fax:805-528-2225
Practice Address - Street 1:2098 9TH ST
Practice Address - Street 2:STE. C
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3239
Practice Address - Country:US
Practice Address - Phone:805-528-2200
Practice Address - Fax:805-528-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty