Provider Demographics
NPI:1841833431
Name:SAMUEL BOBEK PLLC
Entity type:Organization
Organization Name:SAMUEL BOBEK PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBEK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:503-475-4735
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:206-320-2078
Mailing Address - Fax:
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:206-320-2078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty