Provider Demographics
NPI:1780787473
Name:O'BRIEN, JAMES J (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
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 1:1221 4TH AVE E
Mailing Address - Street 2:SUTIE 180
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1681
Mailing Address - Country:US
Mailing Address - Phone:952-445-6657
Mailing Address - Fax:952-445-0674
Practice Address - Street 1:1221 4TH AVE E
Practice Address - Street 2:SUTIE 180
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1681
Practice Address - Country:US
Practice Address - Phone:952-445-6657
Practice Address - Fax:952-445-0674
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND74551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice