Provider Demographics
NPI:1346133956
Name:BOOR, BREANNA EVIEMARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:EVIEMARIE
Last Name:BOOR
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 1:1724 LANESBORO DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3915
Mailing Address - Country:US
Mailing Address - Phone:405-651-4889
Mailing Address - Fax:
Practice Address - Street 1:5004 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-4710
Practice Address - Country:US
Practice Address - Phone:405-299-0562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK80191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice