Healthcare Provider Details

I. General information

NPI: 1841289980
Provider Name (Legal Business Name): CHRISTOPHER J BRECKE D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 VILLA RD SUITE 3
NEWBERG OR
97132-1851
US

IV. Provider business mailing address

504 VILLA RD SUITE 3
NEWBERG OR
97132-1851
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-7358
  • Fax: 503-538-0657
Mailing address:
  • Phone: 503-538-7358
  • Fax: 503-538-0657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD7303
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: