Provider Demographics
NPI:1669408472
Name:QUACKENBUSH, BRETT MICHAEL (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:MICHAEL
Last Name:QUACKENBUSH
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1534 E RAY RD
Mailing Address - Street 2:#121
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4429
Mailing Address - Country:US
Mailing Address - Phone:480-963-8373
Mailing Address - Fax:480-963-4489
Practice Address - Street 1:1534 E RAY RD
Practice Address - Street 2:#121
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4429
Practice Address - Country:US
Practice Address - Phone:480-963-8373
Practice Address - Fax:480-963-4489
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD49631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry