Provider Demographics
NPI:1447242078
Name:PAREDES, BRETT A (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:A
Last Name:PAREDES
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 NEEDHAM ST APT 1204
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1641
Mailing Address - Country:US
Mailing Address - Phone:786-457-5160
Mailing Address - Fax:
Practice Address - Street 1:209 HARVARD ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5071
Practice Address - Country:US
Practice Address - Phone:617-731-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 164971223S0112X
MADN18590601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61002OtherBLUE CROSS/SHIELD