Individual
DR. JAKE OBRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6150 LINE AVE, SHREVEPORT, LA 71106-2051
(318) 868-5726
Mailing address
6150 LINE AVE, SHREVEPORT, LA 71106-2051
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6652
LA
Other
Enumeration date
05/24/2016
Last updated
05/24/2016
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