Provider Demographics
NPI:1447610480
Name:O'BRIEN, BETHANIE A (RDH)
Entity Type:Individual
Prefix:
First Name:BETHANIE
Middle Name:A
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 S PARKER RD # A2-202
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-6215
Mailing Address - Country:US
Mailing Address - Phone:888-337-8777
Mailing Address - Fax:888-337-8777
Practice Address - Street 1:3124 S PARKER RD # A2-202
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6215
Practice Address - Country:US
Practice Address - Phone:888-337-8777
Practice Address - Fax:888-337-8777
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000903110124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist