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General NPI Number Information
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NPI Number | 1700319423
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Entity Type | Organization
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Legal Business Name | BRECKSVILLE KIDS DENTISTRY
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 8801 BRECKSVILLE RD SUITE 5
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City | BRECKSVILLE
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State | OH
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Zip | 44141-1947
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Country | US
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Telephone | 440-838-5445
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Fax |
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Provider Business Mailing Address
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Address Line | 2711 BOSTON RD
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City | BRECKSVILLE
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State | OH
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Zip | 44141-3312
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Country | US
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Telephone | 440-665-8825
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JENNIFER BRYK HECHKO
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Credential | DDS, MS
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Telephone | 440-665-8825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30.021804
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License Number State | OH
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