Provider Demographics
NPI:1528286903
Name:O'BRIEN, BRENDA M (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:M
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 TILLMAN RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9185
Mailing Address - Country:US
Mailing Address - Phone:937-885-9759
Mailing Address - Fax:
Practice Address - Street 1:3300 KEMP RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-4200
Practice Address - Country:US
Practice Address - Phone:937-426-6860
Practice Address - Fax:937-426-9703
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300205361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics