Breanne Dickenson, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

H008839 Issued in AZ

Practice address

2107 Paseo San Luis
Sierra Vista, AZ 85635-4563

Phone

(813) 841-5838

Fax

(813) 841-5838

NPI assigned

Jan 30, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517270400000",
    "number": "1669970117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2470 MONTARO DR",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856501204",
            "telephone_number": "813-841-5838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2107 PASEO SAN LUIS",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856354563",
            "telephone_number": "813-841-5838",
            "fax_number": "813-841-5838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKENSON",
        "first_name": "BREANNE",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-30",
        "last_updated": "2018-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "FL",
            "license": "DH24863",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "AZ",
            "license": "H008839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mohamad Omar Zakaria Diab, MD
• Susan Karen Dobis, REGISTERED NURSE
• Dolores M. Miller
• Donald C Simpson, DDS, PC
• Mustafa Faisal Mustafa Douglas, MD
• Dr Yvonne D Lee and Associates LLC

• Dental Hygienist in Sierra Vista, AZ
• Providers in Sierra Vista, AZ by specialty
• Dental Hygienist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.