Provider Demographics
NPI:1093270217
Name:CARR, BRIAN REZEL (DMD MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:REZEL
Last Name:CARR
Suffix:
Gender:
Credentials:DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 S HOWELL AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-7117
Mailing Address - Country:US
Mailing Address - Phone:414-764-2880
Mailing Address - Fax:
Practice Address - Street 1:7801 S HOWELL AVE STE 202
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-7117
Practice Address - Country:US
Practice Address - Phone:414-764-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001292151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery