Provider Demographics
NPI:1013295567
Name:BRESKIEWICZ, MICHAEL MARTIN III (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MARTIN
Last Name:BRESKIEWICZ
Suffix:III
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:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:PAXINOS
Mailing Address - State:PA
Mailing Address - Zip Code:17860-0107
Mailing Address - Country:US
Mailing Address - Phone:570-509-2703
Mailing Address - Fax:
Practice Address - Street 1:110 MILES RD.
Practice Address - Street 2:
Practice Address - City:PAXINOS
Practice Address - State:PA
Practice Address - Zip Code:17860
Practice Address - Country:US
Practice Address - Phone:570-509-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039046122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program