Provider Demographics
NPI:1083269682
Name:BERTRAND, BREINN ASHLEY (DDS)
Entity Type:Individual
Prefix:
First Name:BREINN
Middle Name:ASHLEY
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 N 46TH ST APT 306
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6860
Mailing Address - Country:US
Mailing Address - Phone:253-579-4103
Mailing Address - Fax:
Practice Address - Street 1:13613 MERIDIAN E STE 180
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3664
Practice Address - Country:US
Practice Address - Phone:253-845-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA609700021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice