Provider Demographics
NPI:1538647946
Name:WILL, BRETT J (DDS)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:J
Last Name:WILL
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 1:5401 6TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2618
Mailing Address - Country:US
Mailing Address - Phone:253-759-5437
Mailing Address - Fax:253-426-1836
Practice Address - Street 1:216 W HERON ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6225
Practice Address - Country:US
Practice Address - Phone:360-532-5437
Practice Address - Fax:360-637-9215
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60862622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist