Healthcare Provider Details

I. General information

NPI: 1659408284
Provider Name (Legal Business Name): DAVID CARL OBENCHAIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3295 SW AVALON WAY SUITE B
SEATTLE WA
98126
US

IV. Provider business mailing address

3295 SW AVALON WAY STE B
SEATTLE WA
98126-2683
US

V. Phone/Fax

Practice location:
  • Phone: 206-561-2345
  • Fax: 206-990-0800
Mailing address:
  • Phone: 206-561-2345
  • Fax: 206-990-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE60102338
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: