Provider Demographics
NPI:1790893030
Name:BRETOS, ALEXANDER LUIS (DMD DOCTORATE OF DEN)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:LUIS
Last Name:BRETOS
Suffix:
Gender:M
Credentials:DMD DOCTORATE OF DEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15502 NW 77TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5804
Mailing Address - Country:US
Mailing Address - Phone:305-822-7332
Mailing Address - Fax:305-822-7281
Practice Address - Street 1:15502 NW 77 CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-822-7332
Practice Address - Fax:305-822-7281
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00119440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist