Provider Demographics
NPI:1740462175
Name:DEAN, BRENETTA (LMT)
Entity type:Individual
Prefix:MS
First Name:BRENETTA
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HIGHLAND TER
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-1948
Mailing Address - Country:US
Mailing Address - Phone:734-686-2304
Mailing Address - Fax:
Practice Address - Street 1:3093 SASHABAW RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4089
Practice Address - Country:US
Practice Address - Phone:734-686-2304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
MI7501016641225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171W00000XOther Service ProvidersContractor