Jon O'Brien, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11606 Issued in MI

Practice address

1503 Coit Ave NE
Grand Rapids, MI 49505-4906

Phone

(616) 361-2617

Fax

(616) 361-2390

NPI assigned

Apr 6, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• O'Brien and O'Brien DDS PC

  • General Practice Dentistry
  • Grand Rapids, MI
  • NPI 1497978290
  NPD (past)

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1922121920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 COIT AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495054906",
            "telephone_number": "616-361-2617",
            "fax_number": "616-361-2390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 COIT AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495054906",
            "telephone_number": "616-361-2617",
            "fax_number": "616-361-2390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "JON",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-06",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "11606",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ID NUMBER",
            "identifier": "11606",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4051278",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Robert O'Brien, D.D.S.
• Delaney Catherine O'Brien, AA
• Gavin O'Brien
• Heather Nicole O'Brien, COTA
• Holly O'Brien, MSN, RNC, WHNP
• Kevin O'Brien
• Meaghan Louise O'Brien, PA-C
• Stephanie Kathleen O'Brien, OTR/L
• Ashley Marie O'Bryan, MD
• Maquana O'Bryan

• General Practice Dentistry in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.