Provider Demographics
NPI:1790523538
Name:NEM, BRIANNE SOPHEARY (DMD)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:SOPHEARY
Last Name:NEM
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 1:16155 NW CORNELL RD STE 450
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-8101
Mailing Address - Country:US
Mailing Address - Phone:971-247-4299
Mailing Address - Fax:
Practice Address - Street 1:16155 NW CORNELL RD STE 450
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8101
Practice Address - Country:US
Practice Address - Phone:971-247-4299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD12029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist