Provider Demographics
NPI:1487188967
Name:O'BRIEN AND WEST, DMD III, PLLC
Entity type:Organization
Organization Name:O'BRIEN AND WEST, DMD III, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTAMARTINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-834-4932
Mailing Address - Street 1:1325 BRADFORD VIEW DR.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-9806
Mailing Address - Country:US
Mailing Address - Phone:919-670-2534
Mailing Address - Fax:
Practice Address - Street 1:1325 BRADFORD VIEW DR.
Practice Address - Street 2:SUITE 120
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-9806
Practice Address - Country:US
Practice Address - Phone:919-670-2534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1578790762Medicaid
NC1568422681Medicaid