Individual
JON O'BRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1503 COIT AVE NE, GRAND RAPIDS, MI 49505-4906
(616) 361-2617
(616) 361-2390
Mailing address
1503 COIT AVE NE, GRAND RAPIDS, MI 49505-4906
(616) 361-2617
(616) 361-2390
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11606
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11606
STATE ID NUMBER
MI
05
—
4051278
—
MI
Enumeration date
04/06/2007
Last updated
07/09/2007
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