Provider Demographics
NPI:1023196086
Name:BRIESE, ANDREW G (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:G
Last Name:BRIESE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 ROGERS AVE
Mailing Address - Street 2:STE. 111
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-2954
Mailing Address - Country:US
Mailing Address - Phone:479-782-0080
Mailing Address - Fax:
Practice Address - Street 1:3200 ROGERS AVE
Practice Address - Street 2:STE. 111
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2954
Practice Address - Country:US
Practice Address - Phone:479-782-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3544122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist