Provider Demographics
NPI:1306820600
Name:BRISKIE, DANIEL MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MICHAEL
Last Name:BRISKIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1411 BUSH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2306
Mailing Address - Country:US
Mailing Address - Phone:810-694-4580
Mailing Address - Fax:810-694-4580
Practice Address - Street 1:1814 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3532
Practice Address - Country:US
Practice Address - Phone:248-608-2626
Practice Address - Fax:248-608-8149
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI142061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1716907Medicaid