Provider Demographics
NPI:1639643539
Name:BREZO, MILENA
Entity Type:Individual
Prefix:DR
First Name:MILENA
Middle Name:
Last Name:BREZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 LEETSDALE DR # 110
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1999
Mailing Address - Country:US
Mailing Address - Phone:720-933-0657
Mailing Address - Fax:
Practice Address - Street 1:7150 LEETSDALE DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1999
Practice Address - Country:US
Practice Address - Phone:720-230-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010229141223G0001X
CODEN00204246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice