Healthcare Provider Details

I. General information

NPI: 1275348203
Provider Name (Legal Business Name): DANIEL KOBRIC BSC, DMD, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 MAIN STREET 250 SQUIRE HALL
BUFFALO NY
14214
US

IV. Provider business mailing address

119 LISA CRES
THORNHILL ONTARIO
L4J 2N2
CA

V. Phone/Fax

Practice location:
  • Phone: 716-829-3845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number064380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: