Individual
DR. DEWAYNE LAVERNE BRISCOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS MD
Contact information
Practice address
404 FAIRWAY LOOP, SUN VALLEY, ID 83353
(208) 720-9546
Mailing address
PO BOX 147, SUN VALLEY, ID 83353-0147
(208) 720-9546
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D-1661-OS
ID
Other
Enumeration date
09/25/2013
Last updated
09/25/2013
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