Provider Demographics
NPI:1043327828
Name:O'BRIEN, DAVID ALLAN (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLAN
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 LOCH RANE BLVD
Mailing Address - Street 2:#122
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5723
Mailing Address - Country:US
Mailing Address - Phone:904-276-0200
Mailing Address - Fax:
Practice Address - Street 1:2141 LOCH RANE BLVD
Practice Address - Street 2:#122
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5723
Practice Address - Country:US
Practice Address - Phone:904-276-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 125351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL69928AMedicare PIN