MEDICARE: B DAVID BREININGER, DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	0401008404	VA

General Provider Information

NPI Number	:	1144613225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B DAVID BREININGER, DDS PC

Provider Business Mailing Address
First Line	:	1453 KEMPSVILLE RD
Second Line	:	SUITE #104
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-7319
Country	:	US
Telephone Number	:	757-467-9622
Fax Number	:	757-467-6920

Provider Business Practice Location Address
First Line	:	1453 KEMPSVILLE RD
Second Line	:	SUITE #104
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-7319
Country	:	US
Telephone Number	:	757-467-9622
Fax Number	:	757-467-6920

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BYRON DAVID BREININGER
Credential	:	DDS
Telephone Number	:	757-467-9622

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	03/12/2015

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