Provider Demographics
NPI:1467655068
Name:LEEMASTER, BRETT ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ALAN
Last Name:LEEMASTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4504 SE 27TH ST
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-4126
Mailing Address - Country:US
Mailing Address - Phone:405-410-3040
Mailing Address - Fax:405-793-8397
Practice Address - Street 1:520 S TELEPHONE RD STE 205
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5425
Practice Address - Country:US
Practice Address - Phone:405-793-8300
Practice Address - Fax:405-793-8397
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice