Provider Demographics
NPI:1114056116
Name:GOBEILLE, DAVID M (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:GOBEILLE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 SW CHANDLER AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3248
Mailing Address - Country:US
Mailing Address - Phone:541-749-4444
Mailing Address - Fax:541-749-2980
Practice Address - Street 1:1725 SW CHANDLER AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3248
Practice Address - Country:US
Practice Address - Phone:541-749-4444
Practice Address - Fax:541-749-2980
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD48971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics