Individual
DR. PETER MICHAEL KOBLAN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
554 LARKFIELD RD, SUITE 107, EAST NORTHPORT, NY 11731-4205
(631) 368-2660
(631) 368-2668
Mailing address
554 LARKFIELD RD, SUITE 107, EAST NORTHPORT, NY 11731-4205
(631) 368-2660
(631) 368-2668
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
046284
NY
Other
Enumeration date
05/05/2010
Last updated
05/05/2010
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