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General NPI Number Information
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NPI Number | 1144425513
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Entity Type | Organization
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Legal Business Name | BINKLEY STREET DENTAL CLINIC PC
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 246 N BINKLEY STREET SUITE B
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City | SOLDOTNA
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State | AK
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Zip | 99669-7522
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Country | US
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Telephone | 907-262-6393
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Fax | 907-262-6244
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Provider Business Mailing Address
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Address Line | 246 N BINKLEY STREET SUITE B
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City | SOLDOTNA
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State | AK
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Zip | 99669-7522
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Country | US
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Telephone | 907-262-6393
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Fax | 907-262-6244
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THOMAS ALLEN KOBYLARZ
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Credential | DDS
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Telephone | 907-262-6393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1091
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License Number State | AK
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