MEDICARE: DR. BREANNA R EMBREE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	9504	AZ

General Provider Information

NPI Number	:	1194089748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BREANNA R EMBREE DDS

Provider Business Mailing Address
First Line	:	2824 N POWER RD STE 108
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1673
Country	:	US
Telephone Number	:	480-641-4567
Fax Number	:

Provider Business Practice Location Address
First Line	:	2824 N POWER RD STE 108
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1673
Country	:	US
Telephone Number	:	480-641-4567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2012
Last Update Date	:	08/09/2024

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