Provider Demographics
NPI:1174618128
Name:BREELAND, NONA ILENE (DDS MS)
Entity type:Individual
Prefix:
First Name:NONA
Middle Name:ILENE
Last Name:BREELAND
Suffix:
Gender:F
Credentials:DDS MS
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Other - Credentials:
Mailing Address - Street 1:1506 E FRANKLIN ST
Mailing Address - Street 2:204
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2825
Mailing Address - Country:US
Mailing Address - Phone:919-967-1776
Mailing Address - Fax:919-967-1990
Practice Address - Street 1:1506 E FRANKLIN ST
Practice Address - Street 2:204
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2825
Practice Address - Country:US
Practice Address - Phone:919-967-1776
Practice Address - Fax:919-967-1990
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC56581223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC570343OtherUNITED CONCORDIA
NC7991086Medicaid
NC91086OtherBLUE CROSS BLUE SHIELD