MEDICARE: BRAKKON SCOTT GARRETT DMD

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	7696	NV

General Provider Information

NPI Number	:	1891415238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAKKON SCOTT GARRETT DMD

Provider Business Mailing Address
First Line	:	6160 W TROPICANA AVE STE E1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4696
Country	:	US
Telephone Number	:	702-858-9466
Fax Number	:

Provider Business Practice Location Address
First Line	:	6160 W TROPICANA AVE STE E1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4696
Country	:	US
Telephone Number	:	702-858-9466
Fax Number	:

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

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	08/29/2022

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