Provider Demographics
NPI:1811730195
Name:JAMES SKYLAR O'BRIEN, DDS, LLC
Entity type:Organization
Organization Name:JAMES SKYLAR O'BRIEN, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SKYLAR
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-880-4111
Mailing Address - Street 1:1716 ONTARIO AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9256
Mailing Address - Country:US
Mailing Address - Phone:318-880-4111
Mailing Address - Fax:
Practice Address - Street 1:2442 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2050
Practice Address - Country:US
Practice Address - Phone:815-748-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty