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General NPI Number Information
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NPI Number | 1386817088
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Entity Type | Individual
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Provider Name | PATRICE EAGAN O'BRIEN R.D.H.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 1217 1ST ST NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-1529
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Country | US
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Telephone | 505-766-5197
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Fax |
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Provider Business Mailing Address
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Address Line | 2904 RHODE ISLAND ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3706
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Country | US
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Telephone |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2418
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License Number State | NM
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