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Individual
COLLEEN M O'BRIEN
Active
Individual
COLLEEN M O'BRIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
30-023656
OH
1223G0001X
General Practice Dentistry
Primary
4123
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810028195
—
WV
Enumeration date
06/06/2011
Last updated
10/02/2015
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