Individual provider · Type 1 NPI
Dewayne Laverne Briscoe, DDS MD
Oral and Maxillofacial Surgery (Dentist) · Sun Valley, ID
NPI number
1003242769
Active
Practice location
404 Fairway Loop
Sun Valley, ID 83353
Mailing address
PO Box 147
Sun Valley, ID 83353-0147
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) Primary | 1223S0112X | D-1661-OS (ID) |
Oral and Maxillofacial Surgery (Dentist): The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
About NPI 1003242769
Dewayne Laverne Briscoe, DDS MD's National Provider Identifier is 1003242769, issued on Sep 25, 2013. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Sun Valley, ID. The record was last updated on Sep 25, 2013.