Provider Demographics
NPI:1659496065
Name:O'BRIEN, CAROL AICHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:AICHA
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 1:7424 BRIDGEPORT WAY W.
Mailing Address - Street 2:#201
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8134
Mailing Address - Country:US
Mailing Address - Phone:253-582-2408
Mailing Address - Fax:253-584-7024
Practice Address - Street 1:7424 BRIDGEPORT WAY W.
Practice Address - Street 2:#201
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8134
Practice Address - Country:US
Practice Address - Phone:253-582-2408
Practice Address - Fax:253-584-7024
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000087891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice