Healthcare Provider Details

I. General information

NPI: 1336338847
Provider Name (Legal Business Name): GIANMARCO O'BRIEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2007
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE SUITE #530
ORANGE CA
92868-4223
US

IV. Provider business mailing address

617 ROCKEFELLER
IRVINE CA
92612-7176
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-1000
  • Fax: 714-953-9957
Mailing address:
  • Phone: 510-908-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number51630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: