Provider Demographics
NPI:1942652433
Name:BRETZ-PAVIE, LUCIANA B (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUCIANA
Middle Name:B
Last Name:BRETZ-PAVIE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LUCIANA
Other - Middle Name:BRETZ
Other - Last Name:PAVIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 MARY ANN DRIVE
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-2843
Mailing Address - Country:US
Mailing Address - Phone:508-825-2020
Mailing Address - Fax:508-825-2223
Practice Address - Street 1:2 MARY ANN DRIVE
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-2843
Practice Address - Country:US
Practice Address - Phone:508-825-2020
Practice Address - Fax:508-825-2223
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18573351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice