Provider Demographics
NPI:1538285309
Name:BRISCOE, TODD PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:PATRICK
Last Name:BRISCOE
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 1:7833 SAINT JOE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9505
Mailing Address - Country:US
Mailing Address - Phone:260-486-9950
Mailing Address - Fax:260-485-1651
Practice Address - Street 1:7833 SAINT JOE CENTER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-9505
Practice Address - Country:US
Practice Address - Phone:260-486-9950
Practice Address - Fax:260-485-1651
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120086791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice