Provider Demographics
NPI:1033288725
Name:KOBAYASHI, LARK C (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARK
Middle Name:C
Last Name:KOBAYASHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1648 E. HERNDON AVE. SUITE #102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-222-5268
Mailing Address - Fax:559-222-9784
Practice Address - Street 1:1648 E. HERNDON AVE. SUITE #102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-222-5268
Practice Address - Fax:559-222-9784
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADK0333606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist