Provider Demographics
NPI:1538790357
Name:OBUNGU, DENNIS ABUGA
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:ABUGA
Last Name:OBUNGU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USA DENTAL HEALTH ACTIVITY
Mailing Address - Street 2:9900 LINCOLN STREET
Mailing Address - City:JBLM
Mailing Address - State:WA
Mailing Address - Zip Code:98431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USA DENTAL HEALTH ACTIVITY
Practice Address - Street 2:9900 LINCOLN STREET
Practice Address - City:JBLM
Practice Address - State:WA
Practice Address - Zip Code:98431
Practice Address - Country:US
Practice Address - Phone:253-968-4079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330X2OtherUS ARMY RDH LICENSE