Provider Demographics
NPI:1316099799
Name:KOBLISH, JEFFREY ARTHUR (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ARTHUR
Last Name:KOBLISH
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 1:491 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2109
Mailing Address - Country:US
Mailing Address - Phone:847-842-1723
Mailing Address - Fax:
Practice Address - Street 1:491 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:NORTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2109
Practice Address - Country:US
Practice Address - Phone:847-842-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190165771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice