Provider Demographics
NPI:1033116207
Name:BREZA, JOHN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:BREZA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15290 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-2029
Mailing Address - Country:US
Mailing Address - Phone:586-294-4990
Mailing Address - Fax:586-294-4871
Practice Address - Street 1:15290 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-2029
Practice Address - Country:US
Practice Address - Phone:586-294-4990
Practice Address - Fax:586-294-4871
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010098251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice