Provider Demographics
NPI:1255473419
Name:O'BRIEN, JOHN A III (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:O'BRIEN
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-1916
Mailing Address - Country:US
Mailing Address - Phone:256-249-3384
Mailing Address - Fax:256-249-8541
Practice Address - Street 1:497 W 3RD ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-1916
Practice Address - Country:US
Practice Address - Phone:256-249-3384
Practice Address - Fax:256-249-8541
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice