Provider Demographics
NPI:1942753215
Name:BREESE DENTAL CARE, PC
Entity Type:Organization
Organization Name:BREESE DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:DROEGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-526-2020
Mailing Address - Street 1:111 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-1629
Mailing Address - Country:US
Mailing Address - Phone:618-526-2020
Mailing Address - Fax:618-526-8330
Practice Address - Street 1:111 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-1629
Practice Address - Country:US
Practice Address - Phone:618-526-2020
Practice Address - Fax:618-526-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020712261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental