Provider Demographics
NPI:1417330614
Name:KAITLYN P. O'BRIEN D.D.S.
Entity Type:Organization
Organization Name:KAITLYN P. O'BRIEN D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-438-5111
Mailing Address - Street 1:7730 N FRESNO ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2408
Mailing Address - Country:US
Mailing Address - Phone:559-438-5111
Mailing Address - Fax:559-438-5120
Practice Address - Street 1:7730 N FRESNO ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2408
Practice Address - Country:US
Practice Address - Phone:559-438-5111
Practice Address - Fax:559-438-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64662261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental