Healthcare Provider Details

I. General information

NPI: 1518464809
Provider Name (Legal Business Name): BREANNE ANDERSON DMD, MS, FACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BREANNE DUFAULT DMD, MS, FACP

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23421 WALDEN CENTER DR STE 300
ESTERO FL
34134-4911
US

IV. Provider business mailing address

23421 WALDEN CENTER DR STE 300
ESTERO FL
34134-4911
US

V. Phone/Fax

Practice location:
  • Phone: 239-300-2767
  • Fax:
Mailing address:
  • Phone: 239-300-2767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number26143
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: