Provider Demographics
NPI:1720295892
Name:KABITZKE, BERNHARD E (DMD)
Entity type:Individual
Prefix:DR
First Name:BERNHARD
Middle Name:E
Last Name:KABITZKE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 MOUNTAIN VW
Mailing Address - Street 2:
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229-2824
Mailing Address - Country:US
Mailing Address - Phone:723-991-4560
Mailing Address - Fax:
Practice Address - Street 1:314 ERNSTON RD
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1937
Practice Address - Country:US
Practice Address - Phone:732-721-3311
Practice Address - Fax:732-721-3543
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0182981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice