Healthcare Provider Details

I. General information

NPI: 1407783640
Provider Name (Legal Business Name): BREANNYCA DENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 INLAND CENTER DR
SAN BERNARDINO CA
92408-1843
US

IV. Provider business mailing address

599 INLAND CENTER DR
SAN BERNARDINO CA
92408-1843
US

V. Phone/Fax

Practice location:
  • Phone: 909-889-2665
  • Fax:
Mailing address:
  • Phone: 909-889-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: