Provider Demographics
NPI:1720219157
Name:PATRICK D. BRIESE, DDS, LLC
Entity Type:Organization
Organization Name:PATRICK D. BRIESE, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BRIESE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-334-3724
Mailing Address - Street 1:400 S ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-5840
Mailing Address - Country:US
Mailing Address - Phone:337-334-3724
Mailing Address - Fax:337-334-3777
Practice Address - Street 1:1143 CHURCH POINT HWY
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578
Practice Address - Country:US
Practice Address - Phone:337-334-3724
Practice Address - Fax:337-334-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental