Provider Demographics
NPI:1093097057
Name:SEATTLE EMERGENCY DENTAL CARE, USA INC
Entity Type:Organization
Organization Name:SEATTLE EMERGENCY DENTAL CARE, USA INC
Other - Org Name:EMERGENCY DENTAL CARE, USA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-597-1186
Mailing Address - Street 1:2605 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3116
Mailing Address - Country:US
Mailing Address - Phone:402-597-1186
Mailing Address - Fax:
Practice Address - Street 1:12816 SE 38TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1327
Practice Address - Country:US
Practice Address - Phone:206-521-9911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEATTLE EMERGENCY DENTAL CARE, USA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600659861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty