Provider Demographics
NPI:1578656146
Name:O'BRIEN, THERESE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:L
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 L ST
Mailing Address - Street 2:#2
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5025
Mailing Address - Country:US
Mailing Address - Phone:916-447-3600
Mailing Address - Fax:916-447-3668
Practice Address - Street 1:2409 L ST
Practice Address - Street 2:#2
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5025
Practice Address - Country:US
Practice Address - Phone:916-447-3600
Practice Address - Fax:916-447-3668
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA403841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice