Provider Demographics
NPI:1598826109
Name:O'BRIEN, DAN PATRICK (DDS)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:PATRICK
Last Name:O'BRIEN
Suffix:
Gender:M
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:JEFFERSON COUNTY HEALTH DEPARTMENT
Mailing Address - Street 2:1818 LONEDELL ROAD
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010
Mailing Address - Country:US
Mailing Address - Phone:636-282-1010
Mailing Address - Fax:636-282-2525
Practice Address - Street 1:JEFFERSON COUNTY HEALTH DEPARTMENT
Practice Address - Street 2:1818 LONEDELL ROAD
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010
Practice Address - Country:US
Practice Address - Phone:636-282-1010
Practice Address - Fax:636-282-2525
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0104021223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010402OtherSTATE OF MISSOURI LICENSE