Provider Demographics
NPI:1558523373
Name:BRICENO, ELIZABETH NICOLE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:BRICENO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:NICOLE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7844 LONG POINT RD.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-3621
Mailing Address - Country:US
Mailing Address - Phone:713-956-8767
Mailing Address - Fax:713-956-1952
Practice Address - Street 1:7844 LONG POINT RD.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3621
Practice Address - Country:US
Practice Address - Phone:713-956-8767
Practice Address - Fax:713-956-1952
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18454122300000X
MA22239122300000X
TX27884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist