Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 18148 | TX |
NPI | 1104847011 |
---|---|
Provider Name | Dr. Stuart O'brien R |
First Address | Sugar Land, TX 77479-6583 |
Second Address | Sugar Land, TX 77479-6583 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2006 |
Last Update Date | 08/07/2007 |