Provider Demographics
NPI:1760918684
Name:O'BRIEN AND WEST, DMD IV, PLLC
Entity Type:Organization
Organization Name:O'BRIEN AND WEST, DMD IV, PLLC
Other - Org Name:NIGHT AND DAY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTAMARTINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-845-6450
Mailing Address - Street 1:6316 E INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-6953
Mailing Address - Country:US
Mailing Address - Phone:919-834-4932
Mailing Address - Fax:
Practice Address - Street 1:6316 E INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-6953
Practice Address - Country:US
Practice Address - Phone:919-834-4932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1568422681Medicaid