Provider Demographics
NPI:1568626091
Name:KOBLISKA, MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KOBLISKA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2098 9TH ST
Mailing Address - Street 2:STE. C
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3239
Mailing Address - Country:US
Mailing Address - Phone:805-528-2200
Mailing Address - Fax:805-528-2225
Practice Address - Street 1:2098 9TH ST
Practice Address - Street 2:STE. C
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3239
Practice Address - Country:US
Practice Address - Phone:805-528-2200
Practice Address - Fax:805-528-2225
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice