Healthcare Provider Details

I. General information

NPI: 1861299349
Provider Name (Legal Business Name): TERESA O'BRIEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W BLACK HORSE PIKE
PLEASANTVILLE NJ
08232-2645
US

IV. Provider business mailing address

50 W BLACK HORSE PIKE
PLEASANTVILLE NJ
08232-2645
US

V. Phone/Fax

Practice location:
  • Phone: 609-641-1065
  • Fax:
Mailing address:
  • Phone: 609-641-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03078900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: