Provider Demographics
NPI:1588350615
Name:OBECK COMPREHENSIVE DENTAL
Entity type:Organization
Organization Name:OBECK COMPREHENSIVE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OBECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-253-5379
Mailing Address - Street 1:33 DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3427
Mailing Address - Country:US
Mailing Address - Phone:813-253-5379
Mailing Address - Fax:813-254-1521
Practice Address - Street 1:33 DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3427
Practice Address - Country:US
Practice Address - Phone:813-253-5379
Practice Address - Fax:813-254-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1053938654Medicaid
FL1316060635Medicaid