Provider Demographics
NPI:1447415757
Name:HARVEY H BRECKNER D.M.D.,M.S
Entity Type:Organization
Organization Name:HARVEY H BRECKNER D.M.D.,M.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-307-3267
Mailing Address - Street 1:600 COUNTRY CLUB VIEW SUITE 4
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025
Mailing Address - Country:US
Mailing Address - Phone:618-307-3267
Mailing Address - Fax:
Practice Address - Street 1:600 COUNTRY CLUB VIEW SUITE 4
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025
Practice Address - Country:US
Practice Address - Phone:618-307-3267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19020061302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization