Provider Demographics
NPI:1437234689
Name:O'BRIEN, KEITH STUART (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:STUART
Last Name:O'BRIEN
Suffix:
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 1:9 PINNACLE DRIVE SUITE 103
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939
Mailing Address - Country:US
Mailing Address - Phone:540-885-1500
Mailing Address - Fax:540-885-2722
Practice Address - Street 1:9 PINNACLE DRIVE SUITE 103
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-885-1500
Practice Address - Fax:540-885-2722
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010088351223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice