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General NPI Number Information
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NPI Number | 1073370441
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Entity Type | Individual
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Provider Name | KENNEDY LEIGH O'BRIEN DMD
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Gender | Female
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 460 KILLIAN RD
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City | COLUMBIA
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State | SC
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Zip | 29203-9742
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Country | US
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Telephone | 803-814-0102
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Fax |
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Provider Business Mailing Address
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Address Line | 2713 EDWARDS ST
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City | ALTON
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State | IL
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Zip | 62002-3917
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Country | US
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Telephone | 978-530-6828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DGD.10854
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License Number State | SC
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