Individual
MR. BRETT IRVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1511 EAST BROADWAY, ST LOUIS, IL 62201
(618) 482-3844
(618) 482-3843
Mailing address
865 N 76TH E, ST LOUIS, IL 62203
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002311
—
IL
05
—
101449
—
IL
Enumeration date
01/29/2007
Last updated
07/08/2007
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