Provider Demographics
NPI:1750386074
Name:BREUM, ANNE MARGARET (DMD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:MARGARET
Last Name:BREUM
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 1:715 KENSINGTON AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5700
Mailing Address - Country:US
Mailing Address - Phone:406-543-8591
Mailing Address - Fax:406-543-9776
Practice Address - Street 1:715 KENSINGTON AVE
Practice Address - Street 2:STE 6
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5700
Practice Address - Country:US
Practice Address - Phone:406-543-8591
Practice Address - Fax:406-543-9776
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5512611OtherCHIPS PROVIDER NUMBER
MT0115375Medicaid