Provider Demographics
NPI:1659408284
Name:OBENCHAIN, DAVID CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CARL
Last Name:OBENCHAIN
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 1:3295 SW AVALON WAY
Mailing Address - Street 2:DENTAL SUITE
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-1055
Mailing Address - Country:US
Mailing Address - Phone:206-561-2345
Mailing Address - Fax:206-990-0800
Practice Address - Street 1:3295 SW AVALON WAY
Practice Address - Street 2:DENTAL SUITE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126
Practice Address - Country:US
Practice Address - Phone:206-561-2345
Practice Address - Fax:206-990-0800
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601023381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5059977Medicaid
WADE60102338OtherDENTAL LICENSE
U62370Medicare UPIN
WAG8943265Medicare PIN
WA7427240001Medicare NSC