1538645809 NPI number — SARA MARIE OBRIEN DMD

Table of content: ROCIO JUAREZ (NPI 1679941074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538645809 NPI number — SARA MARIE OBRIEN DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBRIEN
Provider First Name:
SARA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538645809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 OLD MILL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15301-6738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-503-4435
Provider Business Mailing Address Fax Number:
724-470-9937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6201 STEUBENVILLE PIKE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC KEES ROCKS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15136-1389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-722-1991
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS041856 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223E0200X , with the licence number: DS041856 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)