Healthcare Provider Details

I. General information

NPI: 1811091358
Provider Name (Legal Business Name): BRECK BREWER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 BLACKWOOD AVE
OCOEE FL
34761
US

IV. Provider business mailing address

1291 BLACKWOOD AVE
OCOEE FL
34761-4521
US

V. Phone/Fax

Practice location:
  • Phone: 407-656-0001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN23270
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8161
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: