Provider Demographics
NPI:1285660019
Name:OBMAN, MARK LYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LYLE
Last Name:OBMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1020
Mailing Address - Country:US
Mailing Address - Phone:727-796-1767
Mailing Address - Fax:727-791-4831
Practice Address - Street 1:2708 PARK DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1020
Practice Address - Country:US
Practice Address - Phone:727-796-1767
Practice Address - Fax:727-791-4831
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-00144711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice