Provider Demographics
NPI:1891913893
Name:O'BRIEN, JOHN C (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 291
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-0291
Mailing Address - Country:US
Mailing Address - Phone:856-478-0200
Mailing Address - Fax:
Practice Address - Street 1:729 FRANKLINVILLE RD
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-4705
Practice Address - Country:US
Practice Address - Phone:856-478-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ226521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice