Active NPI
Michael Lee Brechon Jr., DDS
- General Practice Dentistry
- Belvidere, IL
National Provider Identifier
1982127593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019031293
- Practice address
- 115 W Lincoln Ave
Belvidere, IL 61008-3231 - Phone
- (815) 544-2721
- NPI assigned
- Jul 25, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019031293 | IL | Primary |
Addresses
Primary practice location
115 W Lincoln Ave
Belvidere, IL 61008-3231
Mailing address
115 W Lincoln Ave
Belvidere, IL 61008-3231
Phone (815) 544-2721
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019031293 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1982127593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 W LINCOLN AVE",
"city": "BELVIDERE",
"state": "IL",
"postal_code": "610083231",
"telephone_number": "815-544-2721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 W LINCOLN AVE",
"city": "BELVIDERE",
"state": "IL",
"postal_code": "610083231",
"telephone_number": "815-544-2721"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRECHON",
"first_name": "MICHAEL",
"middle_name": "LEE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-25",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019031293",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belvidere, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.