Provider Demographics
NPI:1881620813
Name:O'BRIEN, THOMAS J JR
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:O'BRIEN
Suffix:JR
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 1:6905 PERIMETER LOOP RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9600
Mailing Address - Country:US
Mailing Address - Phone:614-717-3500
Mailing Address - Fax:614-717-0933
Practice Address - Street 1:6905 PERIMETER LOOP RD
Practice Address - Street 2:SUITE 120
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9600
Practice Address - Country:US
Practice Address - Phone:614-717-3500
Practice Address - Fax:614-717-0933
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH176811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice