Provider Demographics
NPI:1366741142
Name:SPERRY, BRETT L (DMD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:L
Last Name:SPERRY
Suffix:
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 1:13925 W. MEEKER BLVD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375
Mailing Address - Country:US
Mailing Address - Phone:623-854-0733
Mailing Address - Fax:623-524-1799
Practice Address - Street 1:13925 W. MEEKER BLVD
Practice Address - Street 2:SUITE 1A
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375
Practice Address - Country:US
Practice Address - Phone:623-854-0733
Practice Address - Fax:623-524-1799
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-20
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZD009907122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program