Provider Demographics
NPI:1043266893
Name:OBEBE, DAYO (DMD)
Entity Type:Individual
Prefix:
First Name:DAYO
Middle Name:
Last Name:OBEBE
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 1:5009 RIVERCHASE DR
Mailing Address - Street 2:BL 1 SUITE B
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7425
Mailing Address - Country:US
Mailing Address - Phone:334-664-1011
Mailing Address - Fax:
Practice Address - Street 1:5009 RIVERCHASE DR
Practice Address - Street 2:BL 1 SUITE B
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7425
Practice Address - Country:US
Practice Address - Phone:334-664-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4726122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice