Provider Demographics
NPI:1750324901
Name:BREECE, GARY LEE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:BREECE
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:402-A S. OAKWOOD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703
Mailing Address - Country:US
Mailing Address - Phone:580-233-2557
Mailing Address - Fax:580-233-2563
Practice Address - Street 1:402 S OAKWOOD RD
Practice Address - Street 2:SUITE A
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4945
Practice Address - Country:US
Practice Address - Phone:580-233-2557
Practice Address - Fax:580-233-2563
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK40151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics