Individual
COLLEEN M O'BRIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
75 SPYROCK LOOP ROAD, LOOKOUT, WV 25868
(304) 574-2076
(304) 574-1068
Mailing address
P.O. BOX 337, SCARBRO, WV 25917-0337
(304) 574-2076
(304) 574-1068
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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