Provider Demographics
NPI:1831359629
Name:BREA, LUIS MANUEL JR
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:MANUEL
Last Name:BREA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-4011
Mailing Address - Country:US
Mailing Address - Phone:203-853-2732
Mailing Address - Fax:203-968-7022
Practice Address - Street 1:606 WEST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-4011
Practice Address - Country:US
Practice Address - Phone:203-853-2732
Practice Address - Fax:203-968-7022
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT83141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice