Provider Demographics
NPI:1366414575
Name:O'BRIEN, RICHARD LANE (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LANE
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2749
Mailing Address - Country:US
Mailing Address - Phone:314-481-3369
Mailing Address - Fax:314-481-5386
Practice Address - Street 1:4607 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2749
Practice Address - Country:US
Practice Address - Phone:314-481-3369
Practice Address - Fax:314-481-5386
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0110551223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice