MEDICARE: DR. DAVID CARL OBENCHAIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DE60102338	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE60102338	OTHER	WA	DENTAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659408284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID CARL OBENCHAIN DDS

Provider Business Mailing Address
First Line	:	3295 SW AVALON WAY STE B
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-2683
Country	:	US
Telephone Number	:	206-561-2345
Fax Number	:	206-990-0800

Provider Business Practice Location Address
First Line	:	3295 SW AVALON WAY
Second Line	:	SUITE B
City	:	SEATTLE
State	:	WA
Zip	:	98126
Country	:	US
Telephone Number	:	206-561-2345
Fax Number	:	206-990-0800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	12/02/2025

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