Provider Demographics
NPI:1710944772
Name:CLERC, BRETT GUY (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:GUY
Last Name:CLERC
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:PO BOX 2046
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-2046
Mailing Address - Country:US
Mailing Address - Phone:520-586-7056
Mailing Address - Fax:520-586-0770
Practice Address - Street 1:475 S OCOTILLO
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-2046
Practice Address - Country:US
Practice Address - Phone:520-586-7056
Practice Address - Fax:520-586-0770
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist