Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 120881 | AK |
N | 204E00000X | Oral & Maxillofacial Surgeon | D5181OS | ID |
NPI | 1437159332 |
---|---|
Provider Name | Dr. Brett Allen Ueeck |
First Address | Sandpoint, ID 83864-0915 |
Second Address | Anchorage, AK 99503-5769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 14/08/2020 |