Healthcare Provider Details

I. General information

NPI: 1205090180
Provider Name (Legal Business Name): LEONARD BRUCE KOBREN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 OLD MAMARONECK RD STE 1C
WHITE PLAINS NY
10605-2025
US

IV. Provider business mailing address

12 OLD MAMARONECK RD STE 1C
WHITE PLAINS NY
10605-2025
US

V. Phone/Fax

Practice location:
  • Phone: 914-948-7177
  • Fax: 914-289-1731
Mailing address:
  • Phone: 914-948-7177
  • Fax: 914-289-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number029919
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: