Provider Demographics
NPI:1407065162
Name:O'BRIEN, MICHAEL EMILE SR (DDS, JD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EMILE
Last Name:O'BRIEN
Suffix:SR
Gender:M
Credentials:DDS, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LOG CABIN LN
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-3923
Mailing Address - Country:US
Mailing Address - Phone:985-863-5956
Mailing Address - Fax:
Practice Address - Street 1:8000 G SR I RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820-7403
Practice Address - Country:US
Practice Address - Phone:225-334-1780
Practice Address - Fax:225-334-1794
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery