Provider Demographics
NPI:1205062296
Name:BREAUD, STEPHEN JOSEPH (DDS,MSD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:BREAUD
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 50TH ST
Mailing Address - Street 2:STE 505
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-3521
Mailing Address - Country:US
Mailing Address - Phone:806-795-5503
Mailing Address - Fax:806-795-1210
Practice Address - Street 1:4630 50TH ST
Practice Address - Street 2:STE 505
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3521
Practice Address - Country:US
Practice Address - Phone:806-795-5503
Practice Address - Fax:806-795-1210
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics