Individual
DR. JODY J O'BRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
250 FULLER ST S, SUITE 250, SHAKOPEE, MN 55379-1681
(952) 445-6657
(952) 445-0674
Mailing address
250 FULLER ST S, SUITE 250, SHAKOPEE, MN 55379-1681
(952) 445-6657
(952) 445-0674
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11027
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3945243-00
MN HEALTH CARE PROGRAM
MN
Enumeration date
08/16/2005
Last updated
03/17/2018
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