Provider Demographics
NPI:1730307836
Name:BREEN, NICHOLAS FRANCIS SR (DMD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:FRANCIS
Last Name:BREEN
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7731 RUDDEROW AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-3315
Mailing Address - Country:US
Mailing Address - Phone:609-471-4191
Mailing Address - Fax:
Practice Address - Street 1:7731 RUDDEROW AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-3315
Practice Address - Country:US
Practice Address - Phone:609-471-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ17104122300000X
PADS026946-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist