Provider Demographics
NPI:1881140531
Name:BRETT A DAMERON DDS INC
Entity type:Organization
Organization Name:BRETT A DAMERON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-992-1384
Mailing Address - Street 1:12320 N. 32ND ST
Mailing Address - Street 2:#1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:602-992-1384
Mailing Address - Fax:602-992-6104
Practice Address - Street 1:12320 N 32ND ST
Practice Address - Street 2:SUITE #1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7154
Practice Address - Country:US
Practice Address - Phone:602-992-1384
Practice Address - Fax:602-992-6104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty