Colleen M O'Brien, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4123 Issued in WV

Practice address

75 Spyrock Loop Road
Lookout, WV 25868

Phone

(304) 574-2076

Fax

(304) 574-1068

NPI assigned

Jun 6, 2011

Last updated

Oct 2, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443744000000",
    "number": "1164716338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 337",
            "city": "SCARBRO",
            "state": "WV",
            "postal_code": "259170337",
            "telephone_number": "304-574-2076",
            "fax_number": "304-574-1068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 SPYROCK LOOP ROAD",
            "city": "LOOKOUT",
            "state": "WV",
            "postal_code": "25868",
            "telephone_number": "304-574-2076",
            "fax_number": "304-574-1068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "COLLEEN",
        "middle_name": "M",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-06",
        "last_updated": "2015-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30-023656",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WV",
            "license": "4123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810028195",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassandra Cottle
• Stephanie Marie Fox
• Kevin Herbaugh
• John G. Hubbard, DDS
• New River Health Association, Inc. (Lisa Elliott Health Center)
• Abigail Lee Sevy
• Ruby Skaggs
• Joel R. Whitaker, DDS

• General Practice Dentistry in Lookout, WV
• Providers in Lookout, WV by specialty
• General Practice Dentistry in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.