Provider Demographics
NPI:1538886791
Name:BRETON GARDENS FAMILY DENTISTRY
Entity type:Organization
Organization Name:BRETON GARDENS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEETWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-455-0720
Mailing Address - Street 1:4144 BRETON RD SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-3856
Mailing Address - Country:US
Mailing Address - Phone:616-455-0720
Mailing Address - Fax:616-455-0815
Practice Address - Street 1:4144 BRETON RD SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-3856
Practice Address - Country:US
Practice Address - Phone:616-455-0720
Practice Address - Fax:616-455-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental