Healthcare Provider Details

I. General information

NPI: 1487829487
Provider Name (Legal Business Name): JOSEPH A KOBERLEIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3869 DARROW RD SUITE 201
STOW OH
44224-2691
US

IV. Provider business mailing address

3869 DARROW RD SUITE 201
STOW OH
44224-2691
US

V. Phone/Fax

Practice location:
  • Phone: 330-688-9922
  • Fax:
Mailing address:
  • Phone: 330-688-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number18241
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: