Provider Demographics
NPI:1467571158
Name:BRISKIN, LEONID R (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEONID
Middle Name:R
Last Name:BRISKIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 W SUNRISE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5434
Mailing Address - Country:US
Mailing Address - Phone:954-475-8100
Mailing Address - Fax:954-475-4072
Practice Address - Street 1:8320 W SUNRISE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5434
Practice Address - Country:US
Practice Address - Phone:954-475-8100
Practice Address - Fax:954-475-4072
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0760994000Medicaid