Provider Demographics
NPI:1952919854
Name:MANLUCU, BRETT ALEXANDER (DDS)
Entity type:Individual
Prefix:DR
First Name:BRETT ALEXANDER
Middle Name:
Last Name:MANLUCU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8518 AUTUMN GRAIN GATE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5883
Mailing Address - Country:US
Mailing Address - Phone:443-745-0624
Mailing Address - Fax:
Practice Address - Street 1:3565 LEE HWY # S3B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-3756
Practice Address - Country:US
Practice Address - Phone:443-745-0624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014170191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty