1871069021 NPI number — BREANNE O'DEAY MSOT, OTRL

Table of content: DR. QURATULANNE MUNEER DMD (NPI 1205248812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871069021 NPI number — BREANNE O'DEAY MSOT, OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'DEAY
Provider First Name:
BREANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSOT, OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELL
Provider Other First Name:
BREANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871069021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
804 N WATER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48708-5620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-573-8266
Provider Business Mailing Address Fax Number:
989-778-1237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 BAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48603-2438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-401-5282
Provider Business Practice Location Address Fax Number:
989-401-5286
Provider Enumeration Date:
10/15/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 114846100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".