1568841799 NPI number — DAVID CARL OBENCHAIN DDS, PLLC

Table of content: (NPI 1568841799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568841799 NPI number — DAVID CARL OBENCHAIN DDS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID CARL OBENCHAIN DDS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568841799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98116-1055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-740-4961
Provider Business Mailing Address Fax Number:
206-990-0800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3295 SW AVALON WAY
Provider Second Line Business Practice Location Address:
DENTAL SUITE
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98126-1055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-561-2345
Provider Business Practice Location Address Fax Number:
206-990-0800
Provider Enumeration Date:
05/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
OBENCHAIN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
CARL
Authorized Official Title or Position:
ORAL & MAXILLOFACIAL SURGEON
Authorized Official Telephone Number:
402-740-4961

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  DE60102338 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2067882 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com