Provider Demographics
NPI:1225112329
Name:O'BRIEN, STEVEN WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WILLIAM
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 1:311 DEWEY ST
Mailing Address - Street 2:P.O. BOX 649
Mailing Address - City:FOLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56329
Mailing Address - Country:US
Mailing Address - Phone:320-968-7062
Mailing Address - Fax:320-968-7440
Practice Address - Street 1:311 DEWEY ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329
Practice Address - Country:US
Practice Address - Phone:320-968-7062
Practice Address - Fax:320-968-7440
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN95401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN55166OBOtherBLUE CROSS BLUE SHIELD
MN40-41433OtherMEDICA