Provider Demographics
NPI:1912250192
Name:O'BRIEN, JASON MEADER (DDS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MEADER
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 CHAPMAN LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-1695
Mailing Address - Country:US
Mailing Address - Phone:707-703-9391
Mailing Address - Fax:
Practice Address - Street 1:301 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5117
Practice Address - Country:US
Practice Address - Phone:707-546-0429
Practice Address - Fax:707-546-3948
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist