Provider Demographics
NPI:1730287434
Name:BREESE DENTAL GROUP PC.
Entity Type:Organization
Organization Name:BREESE DENTAL GROUP PC.
Other - Org Name:TRENTON DENTAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:CAO
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-526-4233
Mailing Address - Street 1:9437 HOLY CROSS LN.
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230
Mailing Address - Country:US
Mailing Address - Phone:618-526-4233
Mailing Address - Fax:618-526-4908
Practice Address - Street 1:9437 HOLY CROSS LN.
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230
Practice Address - Country:US
Practice Address - Phone:618-526-4233
Practice Address - Fax:618-526-4908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty