Provider Demographics
NPI:1164751962
Name:COBLENTZ, WILLIAM J (CONTRACTOR)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:COBLENTZ
Suffix:
Gender:M
Credentials:CONTRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 WALNUT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-9143
Mailing Address - Country:US
Mailing Address - Phone:740-606-8146
Mailing Address - Fax:
Practice Address - Street 1:224 WALNUT CREEK RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-9143
Practice Address - Country:US
Practice Address - Phone:740-606-8146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2005-025171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications