MEDICARE: DR. GARY LEE BREECE D.D.S., M.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	4015	OK

General Provider Information

NPI Number	:	1750324901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY LEE BREECE D.D.S., M.S.

Provider Business Mailing Address
First Line	:	402-A S. OAKWOOD RD
Second Line	:	SUITE A
City	:	ENID
State	:	OK
Zip	:	73703
Country	:	US
Telephone Number	:	580-233-2557
Fax Number	:	580-233-2563

Provider Business Practice Location Address
First Line	:	402 S OAKWOOD RD
Second Line	:	SUITE A
City	:	ENID
State	:	OK
Zip	:	73703-4945
Country	:	US
Telephone Number	:	580-233-2557
Fax Number	:	580-233-2563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/08/2007

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