Provider Demographics
NPI:1245578665
Name:JEFFREY O'BRIEN, D.D.S., S.C.
Entity Type:Organization
Organization Name:JEFFREY O'BRIEN, D.D.S., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-544-4404
Mailing Address - Street 1:W247S3114 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7321
Mailing Address - Country:US
Mailing Address - Phone:262-544-4404
Mailing Address - Fax:262-544-4399
Practice Address - Street 1:W247S3114 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7321
Practice Address - Country:US
Practice Address - Phone:262-544-4404
Practice Address - Fax:262-544-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental