Most Relevant Information
Provider Data
| NPI Number: | 1003242769 |
| Provider Name: | DEWAYNE LAVERNE BRISCOE DDS MD |
| Entity Type: | Individual |
| Taxonomy Code: | 1223S0112X |
| Specialty: | Dentist |
| License Number: | D-1661-OS |
Most Important Dates
| Enumeration Date: | 09/25/2013 |
| Last Updated: | 09/25/2013 |
Provider Practice Location
404 FAIRWAY LOOP
SUN VALLEY
ID
83353
Practice Location Phone/Fax
| Phone: | 2087209546 |
| Fax: |
Provider Mailing Location
PO BOX 147
SUN VALLEY
ID
833530147
Provider Mailing Phone/Fax
| Phone: | 2087209546 |
| Fax: |