Active NPI
Ronald L. O'Brien, D.D.S.
- Dentist
- San Jose, CA
National Provider Identifier
1174673065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 26275
- Practice address
- 6023 Snell Ave
San Jose, CA 95123-4127 - Phone
- (408) 578-8331
- Fax
- (408) 578-0823
- NPI assigned
- Jan 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 26275 | CA | Primary |
Addresses
Primary practice location
6023 Snell Ave
San Jose, CA 95123-4127
Mailing address
6023 Snell Ave
San Jose, CA 95123-4127
Phone (408) 578-8331
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 4, 2016 through Jan 4, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26275 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vidya Bobba Dental Group Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- San Jose, CA
- NPI 1841782406
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174673065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6023 SNELL AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951234127",
"telephone_number": "408-578-8331",
"fax_number": "408-578-0823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6023 SNELL AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951234127",
"telephone_number": "408-578-8331",
"fax_number": "408-578-0823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'BRIEN",
"first_name": "RONALD",
"middle_name": "L.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "26275",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.