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3295 Sw Avalon Way Dental Suite Seattle WA 98126-1055 | |
| (206) 561-2345 | |
| (206) 990-0800 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 3295 Sw Avalon Way, Seattle, Washington |
| Authorized Official Name and Position | David Carl Obenchain (ORAL & MAXILLOFACIAL SURGEON) |
| Authorized Official Contact | 4027404961 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 16068 Seattle WA 98116-1055 Ph: (402) 740-4961 | 3295 Sw Avalon Way Dental Suite Seattle WA 98126-1055 Ph: (206) 561-2345 |
| NPI Number | 1568841799 |
|---|---|
| Provider Enumeration Date | 05/20/2015 |
| Last Update Date | 12/22/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568841799 | NPI | - | NPPES |
| 2067882 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DE60102338 (Washington) | Primary |
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