Provider Demographics
NPI:1255385860
Name:OBRIEN, CHRISTINE (DMD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 SOCIAL STREET
Mailing Address - Street 2:THUNDERMIST HEALTH CENTER
Mailing Address - City:WOOMSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895
Mailing Address - Country:US
Mailing Address - Phone:401-767-4163
Mailing Address - Fax:401-767-4165
Practice Address - Street 1:1219 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893
Practice Address - Country:US
Practice Address - Phone:401-615-2800
Practice Address - Fax:401-615-2805
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN02729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIC054553Medicaid