NPI 1003242769

Dewayne Laverne Briscoe, DDSMD

Practitioner Oral and Maxillofacial Surgery (Dentist) Sun Valley, ID

Practice location

Address: 404 Fairway Loop, Sun Valley, ID 83353
Phone: (208) 720-9546
Mailing address: PO Box 147, Sun Valley, ID 83353-0147

Registered specialties

Oral and Maxillofacial Surgery (Dentist) Primary

Dental Providers Taxonomy 1223S0112X Licence D-1661-OS (ID)

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Registry record

NPI: 1003242769
Entity type: Individual
Sex (as registered): Male
NPI issued: 25 Sep 2013
Record last updated: 25 Sep 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.