Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 36022 | TX |
NPI | 1104099431 |
---|---|
Provider Name | Dr. Nicholas Allen Breig |
First Address | Dallas, TX 75240-5237 |
Second Address | Euless, TX 76039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 17/07/2020 |