Provider Demographics
NPI:1386214914
Name:O'BRIEN, PAIGE MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:MARIE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 LATHROP DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2041
Mailing Address - Country:US
Mailing Address - Phone:408-499-2278
Mailing Address - Fax:
Practice Address - Street 1:15 SIERRA GATE PLZ
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6602
Practice Address - Country:US
Practice Address - Phone:916-786-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-27
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS106222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist