Provider Demographics
NPI:1023832292
Name:BREVICK, TAYLEE JEAN
Entity type:Individual
Prefix:
First Name:TAYLEE
Middle Name:JEAN
Last Name:BREVICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 256TH ST NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-9265
Mailing Address - Country:US
Mailing Address - Phone:360-502-5486
Mailing Address - Fax:
Practice Address - Street 1:8018 178TH ST NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6746
Practice Address - Country:US
Practice Address - Phone:360-502-5486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant