Provider Demographics
NPI:1275613036
Name:DORMER, BRETT A
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:A
Last Name:DORMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2247 FOREST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1062
Mailing Address - Country:US
Mailing Address - Phone:717-545-2232
Mailing Address - Fax:
Practice Address - Street 1:2247 FOREST HILLS DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1062
Practice Address - Country:US
Practice Address - Phone:717-545-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028092L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice