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General NPI Number Information
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NPI Number | 1457052888
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Entity Type | Individual
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Provider Name | BRETT MICHAEL BRACCO
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Gender | Male
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 1418 W 25TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90732-4418
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Country | US
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Telephone | 310-547-4413
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Fax |
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Provider Business Mailing Address
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Address Line | 2069 E 3RD ST APT 11
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City | LONG BEACH
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State | CA
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Zip | 90814-6123
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Country | US
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Telephone | 917-932-4415
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 110783
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License Number State | CA
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