Healthcare Provider Details

I. General information

NPI: 1013049303
Provider Name (Legal Business Name): ARTHUR LEO KOBAL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 LOMBARD ST SUITE A
THOUSAND OAKS CA
91360-5837
US

IV. Provider business mailing address

228 LOMBARD ST SUITE A
THOUSAND OAKS CA
91360-5837
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-0721
  • Fax: 805-496-1142
Mailing address:
  • Phone: 805-497-0721
  • Fax: 805-496-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD20890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: