Provider Demographics
NPI:1376105528
Name:GRESH, BRIEANNA MARY (DMD)
Entity Type:Individual
Prefix:
First Name:BRIEANNA
Middle Name:MARY
Last Name:GRESH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LABRIE LN
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-9646
Mailing Address - Country:US
Mailing Address - Phone:413-275-2423
Mailing Address - Fax:
Practice Address - Street 1:4 LINE ST
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01073-9441
Practice Address - Country:US
Practice Address - Phone:413-527-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18583331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAFG8491879OtherCONTROLLED SUBSTANCE REGISTRATION CERTIFICATE - DEA