Provider Demographics
NPI:1801363247
Name:ANDERSON, BRE'ON MONIQUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRE'ON
Middle Name:MONIQUE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5798 OGEECHEE RD APT 1021
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-9544
Mailing Address - Country:US
Mailing Address - Phone:504-908-4188
Mailing Address - Fax:
Practice Address - Street 1:319 W GENERAL SCREVEN WAY STE H
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3065
Practice Address - Country:US
Practice Address - Phone:912-368-6881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0157641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty