Provider Demographics
NPI:1104099431
Name:BREIG, NICHOLAS ALLEN (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALLEN
Last Name:BREIG
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 PRESTON RD STE 110309
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5237
Mailing Address - Country:US
Mailing Address - Phone:469-858-1890
Mailing Address - Fax:
Practice Address - Street 1:3010 TX-121
Practice Address - Street 2:STE 300
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039
Practice Address - Country:US
Practice Address - Phone:469-858-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX360221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program