Provider Demographics
NPI:1043242399
Name:O'BRYAN, DARIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARIN
Middle Name:
Last Name:O'BRYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2031
Mailing Address - Country:US
Mailing Address - Phone:541-756-1117
Mailing Address - Fax:541-756-3811
Practice Address - Street 1:1957 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2031
Practice Address - Country:US
Practice Address - Phone:541-756-1117
Practice Address - Fax:541-756-3811
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD83531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice