Provider Demographics
NPI:1851878292
Name:DR MAX S BREAZEAL DDS PLLC
Entity Type:Organization
Organization Name:DR MAX S BREAZEAL DDS PLLC
Other - Org Name:DR MAX S BREAZEAL DDS PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-377-3988
Mailing Address - Street 1:2855 SUMMER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3812
Mailing Address - Country:US
Mailing Address - Phone:901-377-3988
Mailing Address - Fax:901-377-9977
Practice Address - Street 1:2855 SUMMER OAKS DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3812
Practice Address - Country:US
Practice Address - Phone:901-377-3988
Practice Address - Fax:901-377-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty