Provider Demographics
NPI:1568610061
Name:DR MICHAEL J BRISENO DDS PLLC
Entity Type:Organization
Organization Name:DR MICHAEL J BRISENO DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:BRISENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-656-6362
Mailing Address - Street 1:12215 TOEPPERWEIN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233
Mailing Address - Country:US
Mailing Address - Phone:210-656-6362
Mailing Address - Fax:210-656-1538
Practice Address - Street 1:12215 TOEPPERWEIN RD
Practice Address - Street 2:STE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233
Practice Address - Country:US
Practice Address - Phone:210-656-6362
Practice Address - Fax:210-656-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty