Provider Demographics
NPI:1902225113
Name:BRESTER, CONSTANCE JOY (DDS)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:JOY
Last Name:BRESTER
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 1:411 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2037
Mailing Address - Country:US
Mailing Address - Phone:360-834-2182
Mailing Address - Fax:
Practice Address - Street 1:403 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2037
Practice Address - Country:US
Practice Address - Phone:360-834-2182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60393670122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist