Provider Demographics
NPI:1932216900
Name:OBERMANN DENTAL
Entity type:Organization
Organization Name:OBERMANN DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:OBERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-351-7153
Mailing Address - Street 1:7251 WEST 20TH ST
Mailing Address - Street 2:BLDG H SUITE 2
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634
Mailing Address - Country:US
Mailing Address - Phone:970-351-7153
Mailing Address - Fax:970-351-7155
Practice Address - Street 1:7251 WEST 20TH ST
Practice Address - Street 2:BLDG H SUITE 2
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634
Practice Address - Country:US
Practice Address - Phone:970-351-7153
Practice Address - Fax:970-351-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty