Provider Demographics
NPI:1093838153
Name:BREEDEN, ALVIN WAYNE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:WAYNE
Last Name:BREEDEN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ALVIN
Other - Middle Name:WAYNE
Other - Last Name:BREEDEN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1156 OLD RIXEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-1526
Mailing Address - Country:US
Mailing Address - Phone:540-825-5599
Mailing Address - Fax:540-825-6061
Practice Address - Street 1:1156 OLD RIXEYVILLE RD
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-1526
Practice Address - Country:US
Practice Address - Phone:540-825-5599
Practice Address - Fax:540-825-6061
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005055122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist