1750871562 NPI number — O'BRIEN AND WEST, DMD V, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750871562 NPI number — O'BRIEN AND WEST, DMD V, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
O'BRIEN AND WEST, DMD V, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1750871562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2945 NEW BERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27610-1213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-834-4932
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
452 SHOTWELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27520-7397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-750-8484
Provider Business Practice Location Address Fax Number:
919-243-2892
Provider Enumeration Date:
05/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
919-834-4932

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1578790762 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1568422681 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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