MEDICARE: LYDIA LISA BRETT DMD, MSD

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	1223P0221X	Pediatric Dentistry	38156	TX
2	1223G0001X	General Practice Dentistry	0401415818	VA

General Provider Information

NPI Number	:	1528586757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA LISA BRETT DMD, MSD

Provider Business Mailing Address
First Line	:	12000 WILCREST DR STE 207
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-1908
Country	:	US
Telephone Number	:	281-495-8828
Fax Number	:

Provider Business Practice Location Address
First Line	:	12000 WILCREST DR STE 207
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-1908
Country	:	US
Telephone Number	:	281-495-8828
Fax Number	:

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

Provider Enumeration Date	:	09/08/2017
Last Update Date	:	06/27/2024

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