Provider Demographics
NPI:1184756561
Name:O'BRIEN, KEVIN T
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3513
Mailing Address - Country:US
Mailing Address - Phone:203-248-2429
Mailing Address - Fax:203-248-3086
Practice Address - Street 1:2330 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3513
Practice Address - Country:US
Practice Address - Phone:203-248-2429
Practice Address - Fax:203-248-3086
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT63901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice