Provider Demographics
NPI:1720292436
Name:BOBEK, SAMUEL LOUIS (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LOUIS
Last Name:BOBEK
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BROADWAY STE 460
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5312
Mailing Address - Country:US
Mailing Address - Phone:206-207-1525
Mailing Address - Fax:206-207-1625
Practice Address - Street 1:600 BROADWAY STE 460
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5312
Practice Address - Country:US
Practice Address - Phone:206-207-1525
Practice Address - Fax:206-207-1625
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60495614204E00000X
WADE604974051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery