Healthcare Provider Details

I. General information

NPI: 1255465985
Provider Name (Legal Business Name): DANIEL GERALD OBRIEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 DAYTON XENIA ROAD
BEAVERCREEK OH
45424
US

IV. Provider business mailing address

3540 DAYTON XENIA ROAD
BEAVERCREEK OH
45432
US

V. Phone/Fax

Practice location:
  • Phone: 937-426-3232
  • Fax: 937-426-4964
Mailing address:
  • Phone: 937-426-3232
  • Fax: 937-426-4964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30020555
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: