Healthcare Provider Details

I. General information

NPI: 1497122501
Provider Name (Legal Business Name): MATTHEW OBRIEN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 S LOGAN BLVD
HOLLIDAYSBURG PA
16648-3032
US

IV. Provider business mailing address

712 S LOGAN BLVD
HOLLIDAYSBURG PA
16648-3032
US

V. Phone/Fax

Practice location:
  • Phone: 814-946-1950
  • Fax:
Mailing address:
  • Phone: 814-946-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS040571
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: