Provider Demographics
NPI:1710262126
Name:DARIN G O'BRYAN DDS LLC
Entity Type:Organization
Organization Name:DARIN G O'BRYAN DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-756-1117
Mailing Address - Street 1:1885 WAITE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-1210
Mailing Address - Country:US
Mailing Address - Phone:541-756-1117
Mailing Address - Fax:541-756-3811
Practice Address - Street 1:1885 WAITE ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-1210
Practice Address - Country:US
Practice Address - Phone:541-756-1117
Practice Address - Fax:541-756-3811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD83531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty