Provider Demographics
NPI:1053316117
Name:BRIGGS, MICHAEL EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EUGENE
Last Name:BRIGGS
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 1:3612 S CLARK ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-4104
Mailing Address - Country:US
Mailing Address - Phone:573-581-4352
Mailing Address - Fax:
Practice Address - Street 1:201 E MONROE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2852
Practice Address - Country:US
Practice Address - Phone:573-581-4352
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO121831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice