Healthcare Provider Details

I. General information

NPI: 1407619463
Provider Name (Legal Business Name): BREANNE BLEAKMORE DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 SAWMILL RD STE 110
DUBLIN OH
43016-5014
US

IV. Provider business mailing address

7215 SAWMILL RD STE 110
DUBLIN OH
43016-5014
US

V. Phone/Fax

Practice location:
  • Phone: 614-764-9755
  • Fax: 614-764-3875
Mailing address:
  • Phone: 614-764-9755
  • Fax: 614-764-3875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: BREANNE BLEAKMORE
Title or Position: OWNER
Credential: DDS
Phone: 614-764-9755