Individual
DR. EDGAR J BREDA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2900 FRANK SCOTT PKWY W, SUITE 960, BELLEVILLE, IL 62223-5000
(618) 233-8080
(618) 233-1192
Mailing address
2900 FRANK SCOTT PKWY W, SUITE 960, BELLEVILLE, IL 62223-5000
(618) 233-8080
(618) 233-1192
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
170644
HEALTHLINK PROVIDER #
IL
01
—
854467
UNITED CONCORDIA PROVIDER
IL
Enumeration date
10/04/2005
Last updated
09/11/2025
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