Provider Demographics
NPI:1518095314
Name:O'BEIRNE, JACQUELINE W (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:W
Last Name:O'BEIRNE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:25 N CODY CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226
Mailing Address - Country:US
Mailing Address - Phone:303-462-1676
Mailing Address - Fax:
Practice Address - Street 1:2323 S WADSWORTH BLVD
Practice Address - Street 2:#1778
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-3275
Practice Address - Country:US
Practice Address - Phone:303-985-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice