Provider Demographics
NPI:1447577184
Name:O'BRIEN, BRENNAN THOMAS I
Entity Type:Individual
Prefix:DR
First Name:BRENNAN
Middle Name:THOMAS
Last Name:O'BRIEN
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 OVERTON RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-5246
Mailing Address - Country:US
Mailing Address - Phone:225-229-6946
Mailing Address - Fax:
Practice Address - Street 1:317 HIGHLAND BLVD STE C
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120
Practice Address - Country:US
Practice Address - Phone:601-445-8904
Practice Address - Fax:601-897-4204
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MS3610-111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program