Provider Demographics
NPI:1689814410
Name:JOSEPH E O'BRIEN DMD PC
Entity type:Organization
Organization Name:JOSEPH E O'BRIEN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-632-7870
Mailing Address - Street 1:394 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3944
Mailing Address - Country:US
Mailing Address - Phone:978-632-7870
Mailing Address - Fax:978-630-2601
Practice Address - Street 1:394 ELM ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3944
Practice Address - Country:US
Practice Address - Phone:978-632-7870
Practice Address - Fax:978-630-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty