Provider Demographics
NPI:1174673065
Name:O'BRIEN, RONALD L (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:O'BRIEN
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 1:6023 SNELL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-4127
Mailing Address - Country:US
Mailing Address - Phone:408-578-8331
Mailing Address - Fax:408-578-0823
Practice Address - Street 1:6023 SNELL AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-4127
Practice Address - Country:US
Practice Address - Phone:408-578-8331
Practice Address - Fax:408-578-0823
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist