Provider Demographics
NPI:1588119200
Name:MICHAEL K. OBENG, D.D.S., PLLC
Entity type:Organization
Organization Name:MICHAEL K. OBENG, D.D.S., PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-393-2726
Mailing Address - Street 1:4245 S 143RD CIR
Mailing Address - Street 2:STE. 7
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-4516
Mailing Address - Country:US
Mailing Address - Phone:402-393-2726
Mailing Address - Fax:
Practice Address - Street 1:5249 DUKE ST
Practice Address - Street 2:STE. 410
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2926
Practice Address - Country:US
Practice Address - Phone:703-650-9326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL K. OBENG, D.D.S., PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty