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General NPI Number Information
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NPI Number | 1447577184
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Entity Type | Individual
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Provider Name | DR. BRENNAN THOMAS O'BRIEN I
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Gender | Male
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 317 HIGHLAND BLVD STE C
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City | NATCHEZ
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State | MS
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Zip | 39120
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Country | US
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Telephone | 601-445-8904
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Fax | 601-897-4204
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Provider Business Mailing Address
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Address Line | 113 OVERTON RD
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City | NATCHEZ
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State | MS
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Zip | 39120-5246
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Country | US
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Telephone | 225-229-6946
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3610-11
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License Number State | MS
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