Healthcare Provider Details

I. General information

NPI: 1871438077
Provider Name (Legal Business Name): GARRETT D. OBENAUF DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 COMMERCE DR STE A
GRAYSLAKE IL
60030-1646
US

IV. Provider business mailing address

205 COMMERCE DR STE A
GRAYSLAKE IL
60030-1646
US

V. Phone/Fax

Practice location:
  • Phone: 224-381-6853
  • Fax:
Mailing address:
  • Phone: 847-548-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GARRETT DAVID OBENAUF
Title or Position: OWNER
Credential: DMD
Phone: 224-381-6853