Provider Demographics
NPI:1407619463
Name:BREANNE BLEAKMORE DDS LLC
Entity Type:Organization
Organization Name:BREANNE BLEAKMORE DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BREANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEAKMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-764-9755
Mailing Address - Street 1:7215 SAWMILL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-5014
Mailing Address - Country:US
Mailing Address - Phone:614-764-9755
Mailing Address - Fax:614-764-3875
Practice Address - Street 1:7215 SAWMILL RD STE 110
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-5014
Practice Address - Country:US
Practice Address - Phone:614-764-9755
Practice Address - Fax:614-764-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty