Provider Demographics
NPI:1982959300
Name:BLEAKMORE, BREANNE HAFER (DDS)
Entity Type:Individual
Prefix:DR
First Name:BREANNE
Middle Name:HAFER
Last Name:BLEAKMORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3793 FAIRWAY PARK DR
Mailing Address - Street 2:APT 106
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-1674
Mailing Address - Country:US
Mailing Address - Phone:937-238-1585
Mailing Address - Fax:
Practice Address - Street 1:4565 DRESSLER RD NW
Practice Address - Street 2:#101
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2549
Practice Address - Country:US
Practice Address - Phone:330-493-9457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023718122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist