Healthcare Provider Details

I. General information

NPI: 1205853124
Provider Name (Legal Business Name): GREGORY A COBETTO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY 800 ROSE STREET ROOM D508
LEXINGTON KY
40536-0297
US

IV. Provider business mailing address

UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY 800 ROSE STREET ROOM D508
LEXINGTON KY
40536-0297
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6101
  • Fax: 859-323-0066
Mailing address:
  • Phone: 859-323-6101
  • Fax: 859-323-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7712
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number7712
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: