Healthcare Provider Details

I. General information

NPI: 1083550651
Provider Name (Legal Business Name): REECE BREUCKMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 POST ST STE 1205
SAN FRANCISCO CA
94102-1303
US

IV. Provider business mailing address

3810 SACRAMENTO ST APT 201
SAN FRANCISCO CA
94118-1645
US

V. Phone/Fax

Practice location:
  • Phone: 415-200-1283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: