Breda, Edgar J

Breda, Edgar J is an individual health care provider with primary practice located at 2900 Frank Scott Pkwy W Suite 960, Belleville IL 62223-5000. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / Oral and Maxillofacial Surgery. Dental Providers / Dentist is his primary health care specialty. Breda, Edgar J can be contacted via phone (618) 233-8080.

Contact Information

Primary practice address
2900 Frank Scott Pkwy W Suite 960 Belleville IL 62223-5000
Phone: (618) 233-8080
Fax: (618) 233-1192
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X Illinois
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X Illinois

Profile Details

NPI number 1497742407
LBN Legal business name Breda, Edgar J
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 4th, 2005
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497742407 NPPES
Illinois Other 854467 UNITED CONCORDIA PROVIDER
Illinois Other 170644 UNITED CONCORDIA PROVIDER

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