MEDICARE: DR. BYRON DAVID BREININGER 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	122300000X	Dentist	0401008404	VA
2	122300000X	Dentist	12008678A	IN

General Provider Information

NPI Number	:	1972573558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BYRON DAVID BREININGER DDS

Provider Business Mailing Address
First Line	:	1453 KEMPSVILLE RD
Second Line	:	SUITE #104
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-7319
Country	:	US
Telephone Number	:	757-467-9622
Fax Number	:	757-467-6920

Provider Business Practice Location Address
First Line	:	1453 KEMPSVILLE RD
Second Line	:	SUITE #104
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-7319
Country	:	US
Telephone Number	:	757-467-9622
Fax Number	:	757-467-6920

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	03/17/2015

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