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General NPI Number Information
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NPI Number | 1982959300
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Entity Type | Individual
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Provider Name | BREANNE HAFER BLEAKMORE DDS
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Gender | Female
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 4565 DRESSLER RD NW #101
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City | CANTON
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State | OH
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Zip | 44718-2549
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Country | US
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Telephone | 330-493-9457
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Fax |
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Provider Business Mailing Address
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Address Line | 3793 FAIRWAY PARK DR APT 106
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City | COPLEY
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State | OH
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Zip | 44321-1674
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Country | US
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Telephone | 937-238-1585
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30-023718
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License Number State | OH
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