Individual
BREONA LISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
38 17 GRUBER RD, FORT BRAGG, NC 28303
(910) 396-5012
Mailing address
6415 INDEPENDENCE PLACE DR APT 213, FAYETTEVILLE, NC 28303-4395
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
11689
NC
Other
Enumeration date
05/24/2019
Last updated
05/27/2019
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