Provider Demographics
NPI:1780815761
Name:LOISEAU, BRIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIEL
Middle Name:
Last Name:LOISEAU
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 1:836 SHARON AVE E
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2442
Mailing Address - Country:US
Mailing Address - Phone:509-765-1748
Mailing Address - Fax:509-766-7668
Practice Address - Street 1:836 SHARON AVE E
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2442
Practice Address - Country:US
Practice Address - Phone:509-765-1748
Practice Address - Fax:509-766-7668
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600999711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice