Individual
CARLOS A BRISENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RDH
Contact information
Practice address
1705 W MAIN ST, MESA, AZ 85201-6920
(623) 583-3001
Mailing address
762 E GLACIER DR, CHANDLER, AZ 85249-3068
(480) 980-0016
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H05153
AZ
Other
Enumeration date
06/24/2020
Last updated
06/24/2020
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