Provider Demographics
NPI:1720484553
Name:OBRIEN, PAULINE
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DUDLEY RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01468-1233
Mailing Address - Country:US
Mailing Address - Phone:978-939-2536
Mailing Address - Fax:
Practice Address - Street 1:100 DUDLEY RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:MA
Practice Address - Zip Code:01468-1233
Practice Address - Country:US
Practice Address - Phone:978-939-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11447124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist