Provider Demographics
NPI:1265967822
Name:STEVEN A. BRAZEAU, DDS
Entity type:Organization
Organization Name:STEVEN A. BRAZEAU, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRAZEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-965-1861
Mailing Address - Street 1:1514 W YAKIMA AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2951
Mailing Address - Country:US
Mailing Address - Phone:509-457-6175
Mailing Address - Fax:509-457-1139
Practice Address - Street 1:1514 W YAKIMA AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2951
Practice Address - Country:US
Practice Address - Phone:509-457-6175
Practice Address - Fax:509-457-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5054261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental