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General NPI Number Information
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NPI Number | 1851556179
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Entity Type | Organization
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Legal Business Name | HARVEY H. BRECKNER D.M.D.,M.S.
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Dates
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Enumeration Date | 07/25/2008
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 4933 BENCHMARK CENTRE DR. SUITE A
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City | SWANSEA
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State | IL
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Zip | 62226
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Country | US
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Telephone | 618-206-2396
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Fax |
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Provider Business Mailing Address
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Address Line | 4933 BENCHMARK CENTRE DR. SUITE A
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City | SWANSEA
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State | IL
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Zip | 62226
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Country | US
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Telephone | 618-206-2396
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. HARVEY H BRECKNER
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Credential |
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Telephone | 618-206-2396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 19020061
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License Number State | IL
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