Provider Demographics
NPI:1023267408
Name:O'BRIEN, DENNIS MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:MICHAEL
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 LAKE MURRAY BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1334
Mailing Address - Country:US
Mailing Address - Phone:619-337-2970
Mailing Address - Fax:
Practice Address - Street 1:5308 LAKE MURRAY BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1334
Practice Address - Country:US
Practice Address - Phone:619-337-2970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008024051122300000X
CA57392122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist