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General NPI Number Information
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NPI Number | 1497978290
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Entity Type | Organization
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Legal Business Name | O'BRIEN AND O'BRIEN DDS PC
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1503 COIT AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-4906
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Country | US
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Telephone | 616-361-2617
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Fax | 616-361-2390
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Provider Business Mailing Address
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Address Line | 1503 COIT AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-4906
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Country | US
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Telephone | 616-361-2617
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Fax | 616-361-2390
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Authorized Official
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Title or Position | DENTAL INSURANCE SPECIALIST
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Name | BRENDA SALADIN
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Credential |
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Telephone | 616-361-2617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11606
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License Number State | MI
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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 | 11607
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License Number State | MI
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