Provider Demographics
NPI:1336290006
Name:BRIGGS-PERSONENI, JENISE (DDS)
Entity Type:Individual
Prefix:
First Name:JENISE
Middle Name:
Last Name:BRIGGS-PERSONENI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2903
Mailing Address - Country:US
Mailing Address - Phone:707-584-3718
Mailing Address - Fax:
Practice Address - Street 1:1310 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2903
Practice Address - Country:US
Practice Address - Phone:707-584-3718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry