Provider Demographics
NPI:1710033634
Name:OBERMANN, WILLIAM KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KENT
Last Name:OBERMANN
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 1:5332 PARADISE LN
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-4323
Mailing Address - Country:US
Mailing Address - Phone:970-227-7990
Mailing Address - Fax:
Practice Address - Street 1:1220 OAK PARK DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-7302
Practice Address - Country:US
Practice Address - Phone:970-223-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1052001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02052009Medicaid