Provider Demographics
NPI:1215421383
Name:MASTRIANNI, BRIANNA (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:
Last Name:MASTRIANNI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18092 SE LAUREL LEAF LN
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-1433
Mailing Address - Country:US
Mailing Address - Phone:561-310-5227
Mailing Address - Fax:
Practice Address - Street 1:7070 SEMINOLE PRATT WHITNEY RD STE 3
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-3491
Practice Address - Country:US
Practice Address - Phone:561-798-7410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist