MEDICARE: DR. WILLIAM O'BRIEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	3185	LA

General Provider Information

NPI Number	:	1285851634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM O'BRIEN DDS

Provider Business Mailing Address
First Line	:	2790 GAUSE BLVD E
Second Line	:	STE 1
City	:	SLIDELL
State	:	LA
Zip	:	70461-4246
Country	:	US
Telephone Number	:	985-649-9359
Fax Number	:

Provider Business Practice Location Address
First Line	:	2790 GAUSE BLVD E
Second Line	:	STE 1
City	:	SLIDELL
State	:	LA
Zip	:	70461-4246
Country	:	US
Telephone Number	:	985-649-9359
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/08/2007

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