Healthcare Provider Details

I. General information

NPI: 1225299910
Provider Name (Legal Business Name): TRACEY HEIKEN BRESLER D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 RIDGE AVE
PHILADELPHIA PA
19128-2446
US

IV. Provider business mailing address

834 PARADISE DR
AMBLER PA
19002-2340
US

V. Phone/Fax

Practice location:
  • Phone: 215-483-6633
  • Fax:
Mailing address:
  • Phone: 305-725-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS038634
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN18325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: