Provider Demographics
NPI:1619066180
Name:COBAIN, LEIF BRADLY (DDS)
Entity Type:Individual
Prefix:
First Name:LEIF
Middle Name:BRADLY
Last Name:COBAIN
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 1:216 VALLEY CREEK LN
Mailing Address - Street 2:APT F
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-2535
Mailing Address - Country:US
Mailing Address - Phone:925-831-0331
Mailing Address - Fax:
Practice Address - Street 1:5756 PACIFIC AVE
Practice Address - Street 2:SUITE 75
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5160
Practice Address - Country:US
Practice Address - Phone:209-472-1765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics