Healthcare Provider Details

I. General information

NPI: 1053003434
Provider Name (Legal Business Name): MARK ROBERT BREINHOLT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SQUALICUM PKWY STE 103
BELLINGHAM WA
98225-1933
US

IV. Provider business mailing address

104 6TH ST
LYNDEN WA
98264-1959
US

V. Phone/Fax

Practice location:
  • Phone: 360-734-6728
  • Fax: 360-756-8970
Mailing address:
  • Phone: 360-354-0206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDENT.DE.61445260
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: