Provider Demographics
NPI:1881189553
Name:BREITBACH, JEFFRY D (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFRY
Middle Name:D
Last Name:BREITBACH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 ELM ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3686
Mailing Address - Country:US
Mailing Address - Phone:563-690-2850
Mailing Address - Fax:
Practice Address - Street 1:3455 STONEMAN RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-5269
Practice Address - Country:US
Practice Address - Phone:563-566-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09573122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist