Provider Demographics
NPI:1649330192
Name:BREEZE, JANE ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELIZABETH
Last Name:BREEZE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 YMCA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2661
Mailing Address - Country:US
Mailing Address - Phone:636-937-3030
Mailing Address - Fax:636-937-3047
Practice Address - Street 1:1330 YMCA DR
Practice Address - Street 2:SUITE 400
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2661
Practice Address - Country:US
Practice Address - Phone:636-937-3030
Practice Address - Fax:636-937-3047
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010202781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice