Provider Demographics
NPI:1154988483
Name:O'BRIEN, KELLY JEAN (CDA, RDH, MED)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:CDA, RDH, MED
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JEAN
Other - Last Name:DODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:NHTI-CONCORD'S COMMUNITY COLLEGE
Mailing Address - Street 2:31 COLLEGE DRIVE
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-271-6484
Mailing Address - Fax:
Practice Address - Street 1:NHTI-CONCORD'S COMMUNITY COLLEGE
Practice Address - Street 2:31 COLLEGE DRIVE
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-271-6484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02411124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist