Provider Demographics
NPI:1902516859
Name:MCKEAN, BRETT SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:SCOTT
Last Name:MCKEAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4997 BROOKHILL PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-5911
Mailing Address - Country:US
Mailing Address - Phone:951-907-9653
Mailing Address - Fax:
Practice Address - Street 1:1744 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5364
Practice Address - Country:US
Practice Address - Phone:951-782-9585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist