Provider Demographics
NPI:1033085733
Name:FANNIN, BRIANA ALEXIS (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIANA
Middle Name:ALEXIS
Last Name:FANNIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19450 HEAVENS HILL LN
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34715-9262
Mailing Address - Country:US
Mailing Address - Phone:407-456-4307
Mailing Address - Fax:
Practice Address - Street 1:19450 HEAVENS HILL LN
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34715-9262
Practice Address - Country:US
Practice Address - Phone:407-456-4307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-11
Last Update Date:2025-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN31080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty