Provider Demographics
NPI:1598852303
Name:KOBERNIK, JEFFREY ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:KOBERNIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:JEFF
Other - Middle Name:A
Other - Last Name:KOBERNIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1616 SW 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801
Mailing Address - Country:US
Mailing Address - Phone:541-278-3406
Mailing Address - Fax:
Practice Address - Street 1:1100 SOUTHGATE
Practice Address - Street 2:SUITE 17
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3974
Practice Address - Country:US
Practice Address - Phone:541-276-1561
Practice Address - Fax:541-276-5743
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD87841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice