Provider Demographics
NPI:1639337058
Name:O'BRIEN CONROY DENTAL GROUP, LTD.
Entity Type:Organization
Organization Name:O'BRIEN CONROY DENTAL GROUP, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-717-3500
Mailing Address - Street 1:6905 HOSPITAL DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9600
Mailing Address - Country:US
Mailing Address - Phone:614-717-3500
Mailing Address - Fax:614-717-0933
Practice Address - Street 1:6905 HOSPITAL DR
Practice Address - Street 2:SUITE 120
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9600
Practice Address - Country:US
Practice Address - Phone:614-717-3500
Practice Address - Fax:614-717-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH518330OtherUNITED CONCORDIA
OH480694OtherANTHEM