Provider Demographics
NPI:1770652075
Name:SOBCZAK WENCEL RESTORATIVE DENTISTRY PLLC
Entity type:Organization
Organization Name:SOBCZAK WENCEL RESTORATIVE DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SOBCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-485-9557
Mailing Address - Street 1:18323 98TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011
Mailing Address - Country:US
Mailing Address - Phone:425-485-9557
Mailing Address - Fax:425-402-6837
Practice Address - Street 1:18323 98TH AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011
Practice Address - Country:US
Practice Address - Phone:425-485-9557
Practice Address - Fax:425-402-6837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty