Provider Demographics
NPI:1295507721
Name:BRIARWOOD DENTAL PARTNERS, LLC
Entity type:Organization
Organization Name:BRIARWOOD DENTAL PARTNERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NAZANIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZISHARIF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-476-2317
Mailing Address - Street 1:1042 FAIRVIEW AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-2600
Mailing Address - Country:US
Mailing Address - Phone:270-746-5880
Mailing Address - Fax:
Practice Address - Street 1:1042 FAIRVIEW AVE STE C
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-2600
Practice Address - Country:US
Practice Address - Phone:270-746-5880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1194194431OtherMILITARY
1942678495OtherMILITARY
KY1871640888Medicaid