Provider Demographics
NPI:1760835474
Name:MUMM-REED, BREANNE
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:MUMM-REED
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 1:55 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:IA
Mailing Address - Zip Code:50438-1108
Mailing Address - Country:US
Mailing Address - Phone:641-923-3771
Mailing Address - Fax:
Practice Address - Street 1:55 STATE ST
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:IA
Practice Address - Zip Code:50438-1108
Practice Address - Country:US
Practice Address - Phone:641-923-3771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-093181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice