Healthcare Provider Details

I. General information

NPI: 1598089872
Provider Name (Legal Business Name): THOMAS ALLEN KOBYLARZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 N BINKLEY ST
SOLDOTNA AK
99669-7522
US

IV. Provider business mailing address

246 N BINKLEY ST
SOLDOTNA AK
99669-7522
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-6393
  • Fax: 907-262-6244
Mailing address:
  • Phone: 907-262-6393
  • Fax: 907-262-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1091
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: