Provider Demographics
NPI:1366553570
Name:BRESLAUER, GARY L (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:BRESLAUER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2233
Mailing Address - Country:US
Mailing Address - Phone:317-257-3368
Mailing Address - Fax:317-257-5909
Practice Address - Street 1:6117 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:ID
Practice Address - Zip Code:46220
Practice Address - Country:US
Practice Address - Phone:317-257-3368
Practice Address - Fax:317-257-5909
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12007547A126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant