Provider Demographics
NPI:1457711541
Name:O'BRIEN, KAITLYN PATRICIA (DDS)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:PATRICIA
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 N FRESNO ST
Mailing Address - Street 2:SUITE #103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2408
Mailing Address - Country:US
Mailing Address - Phone:559-438-5111
Mailing Address - Fax:559-438-5120
Practice Address - Street 1:7730 N FRESNO ST
Practice Address - Street 2:SUITE #103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2408
Practice Address - Country:US
Practice Address - Phone:559-438-5111
Practice Address - Fax:559-438-5120
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64662122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist