Provider Demographics
NPI:1467669069
Name:BRAZEAU, LISAMARIE (DDS, MS, PS)
Entity Type:Individual
Prefix:DR
First Name:LISAMARIE
Middle Name:
Last Name:BRAZEAU
Suffix:
Gender:F
Credentials:DDS, MS, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N EMERSON AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-6619
Mailing Address - Country:US
Mailing Address - Phone:509-663-7135
Mailing Address - Fax:509-664-3786
Practice Address - Street 1:620 N EMERSON AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6619
Practice Address - Country:US
Practice Address - Phone:509-663-7135
Practice Address - Fax:509-664-3786
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000098811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics