Provider Demographics
NPI:1124184643
Name:OBRIEN, JENNIFER DORATHY (RDH)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DORATHY
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:64 DOLANS LANE
Mailing Address - City:HUNTER
Mailing Address - State:NY
Mailing Address - Zip Code:12442
Mailing Address - Country:US
Mailing Address - Phone:518-263-4555
Mailing Address - Fax:518-263-5238
Practice Address - Street 1:282 NEW HACKENSACK RD
Practice Address - Street 2:MID HUDSON DENTAL
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12590
Practice Address - Country:US
Practice Address - Phone:845-462-1118
Practice Address - Fax:845-462-1142
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY021899124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist