Provider Demographics
NPI:1568422681
Name:O'BRIEN, PATRICK S (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:S
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 1:5511 RAEFORD RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2057
Mailing Address - Country:US
Mailing Address - Phone:910-485-0023
Mailing Address - Fax:407-788-3572
Practice Address - Street 1:5511 RAEFORD RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2057
Practice Address - Country:US
Practice Address - Phone:910-485-0023
Practice Address - Fax:407-788-3572
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN164091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076996700Medicaid