Healthcare Provider Details

I. General information

NPI: 1659342103
Provider Name (Legal Business Name): LAWRENCE JAY KOBREN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 GREAT NECK RD 300
GREAT NECK NY
11021-4308
US

IV. Provider business mailing address

488 GREAT NECK RD 300
GREAT NECK NY
11021-4308
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-5222
  • Fax: 516-466-5525
Mailing address:
  • Phone: 516-466-5222
  • Fax: 516-466-5525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number039738
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: