Provider Demographics
NPI:1205853124
Name:COBETTO, GREGORY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:COBETTO
Suffix:
Gender:M
Credentials:DMD
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Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
Mailing Address - Street 2:800 ROSE STREET ROOM D508
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0297
Mailing Address - Country:US
Mailing Address - Phone:859-323-6101
Mailing Address - Fax:859-323-0066
Practice Address - Street 1:UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
Practice Address - Street 2:800 ROSE STREET ROOM D508
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0297
Practice Address - Country:US
Practice Address - Phone:859-323-6101
Practice Address - Fax:859-323-0066
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY77121223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0037858OtherMEDICARE PTAN
KY64031842Medicaid
KY60003175Medicaid
KY64031842Medicaid
KY60003175Medicaid
KY0575010Medicare ID - Type Unspecified
KY0047510Medicare ID - Type Unspecified
KY0574710Medicare ID - Type Unspecified
KY0997507Medicare ID - Type Unspecified
KY0574810Medicare ID - Type Unspecified
KY0047410Medicare ID - Type Unspecified