Provider Demographics
NPI:1700862760
Name:BRISCOE, LEA H (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEA
Middle Name:H
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 FREESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-9152
Mailing Address - Country:US
Mailing Address - Phone:502-598-1892
Mailing Address - Fax:502-839-1454
Practice Address - Street 1:147 W WOODFORD ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1100
Practice Address - Country:US
Practice Address - Phone:502-839-0121
Practice Address - Fax:502-839-1454
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY71461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY611376101OtherTAX ID