Healthcare Provider Details

I. General information

NPI: 1821476490
Provider Name (Legal Business Name): BRETT MICHAEL SPRINGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E ORANGEBURG AVE STE A
MODESTO CA
95350-5355
US

IV. Provider business mailing address

201 E ORANGEBURG AVE STE A
MODESTO CA
95350-5355
US

V. Phone/Fax

Practice location:
  • Phone: 209-527-5050
  • Fax:
Mailing address:
  • Phone: 209-527-5050
  • Fax: 209-527-0659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number65239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: