Jeffrey Alan Kobernik, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D8784 Issued in OR

Practice address

1100 Southgate
Suite 17
Pendleton, OR 97801-3974

Phone

(541) 276-1561

Fax

(541) 276-5743

NPI assigned

Oct 5, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jeff A. Kobernik Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medical Center Dental Office, LLC

  • Dental Clinic/Center
  • Pendleton, OR
  • NPI 1649584400
  NPD (past)
• Medical Center Dental, LLC

  • General Practice Dentistry
  • Pendleton, OR
  • NPI 1285903047
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1598852303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 SW 1ST STREET",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "97801",
            "telephone_number": "541-278-3406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 SOUTHGATE",
            "address_2": "SUITE 17",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978013974",
            "telephone_number": "541-276-1561",
            "fax_number": "541-276-5743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOBERNIK",
        "first_name": "JEFFREY",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D8784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEFF",
            "last_name": "KOBERNIK",
            "middle_name": "A.",
            "credential": "D.M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nora Kiggins, MA
• Lexus King
• Amity Lorraine Kirkland, D.P.M
• Miriam M Kirse, PA-C
• Clinton E Kittrell, MSW
• Matthew Alan Kobzeff, CRM
• Natalie M. Kollross, PSY.D.
• Andrew John Koskenmaki, QMHA
• Levonne F Kountz, MSW, LCSW
• Kelsey Lee Krosting, RN

• General Practice Dentistry in Pendleton, OR
• Providers in Pendleton, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.