Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 010402 | MO |
NPI | 1598826109 |
---|---|
Provider Name | Dan Patrick O'brien |
First Address | Arnold, MO 63010 |
Second Address | Arnold, MO 63010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010402 | STATE OF MISSOURI LICENSE (01) | MO |