Individual provider Active NPI

Daniel Robert O'Brien, D.D.S.

  • General Practice Dentistry
  • Grand Rapids, MI
National Provider Identifier
1992143093
Registry record updated Jun 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901020932 Issued in MI
Practice address
1503 Coit Ave NE
Grand Rapids, MI 49505-4906
Phone
(616) 361-2617
Fax
(616) 361-2390
NPI assigned
Jun 11, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901020932 MI Primary

Addresses

Primary practice location

1503 Coit Ave NE
Grand Rapids, MI 49505-4906

Mailing address

1503 Coit Ave NE
Grand Rapids, MI 49505-4906
Phone (616) 361-2617

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150608002247 MI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 1951622539

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901020932MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
O'Brien and O'Brien DDS PC General Practice 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.

NPI Registry JSON

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

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370908800000",
    "number": "1992143093",
    "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": "DANIEL",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-11",
        "last_updated": "2013-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901020932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.