Provider Demographics
NPI:1629137633
Name:KOBYLNYK, WILLIAM TARAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TARAS
Last Name:KOBYLNYK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 CASCADE PL
Mailing Address - Street 2:#114
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3148
Mailing Address - Country:US
Mailing Address - Phone:360-707-5670
Mailing Address - Fax:360-707-5670
Practice Address - Street 1:1250 S BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3316
Practice Address - Country:US
Practice Address - Phone:360-755-5600
Practice Address - Fax:360-755-9384
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist