Provider Demographics
NPI:1104961648
Name:O'BRIEN, CHARLES MICHAEL (DMD, PC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BUCKHEAD LN
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-7645
Mailing Address - Country:US
Mailing Address - Phone:334-821-8800
Mailing Address - Fax:334-821-8838
Practice Address - Street 1:836 NORTH DEAN RD.
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2858
Practice Address - Country:US
Practice Address - Phone:334-821-8800
Practice Address - Fax:334-821-8838
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00523525OtherUNITED CONCORDIA
AL510-90422OtherBLUE CROSS BLUE SHIELD