Provider Demographics
NPI:1932666930
Name:CHROBOCINSKI, KAITLIN ANNA (DMD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANNA
Last Name:CHROBOCINSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 N BANCROFT PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2669
Mailing Address - Country:US
Mailing Address - Phone:302-658-7871
Mailing Address - Fax:
Practice Address - Street 1:1110 N BANCROFT PKWY STE 1
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2669
Practice Address - Country:US
Practice Address - Phone:302-658-7871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00115291223P0300X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty