Provider Demographics
NPI:1497978290
Name:O'BRIEN AND O'BRIEN DDS PC
Entity Type:Organization
Organization Name:O'BRIEN AND O'BRIEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALADIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-361-2617
Mailing Address - Street 1:1503 COIT AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-4906
Mailing Address - Country:US
Mailing Address - Phone:616-361-2617
Mailing Address - Fax:616-361-2390
Practice Address - Street 1:1503 COIT AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-4906
Practice Address - Country:US
Practice Address - Phone:616-361-2617
Practice Address - Fax:616-361-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI116071223G0001X
MI116061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11606OtherSTATE ID NUMBER
MI4051278Medicaid
MI4051287Medicaid
MI11607OtherSTATE ID NUMBER