MEDICARE: DR. DANIEL MICHAEL BRISKIE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	14206	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306820600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL MICHAEL BRISKIE DDS

Provider Business Mailing Address
First Line	:	1411 BUSH CREEK DR
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2306
Country	:	US
Telephone Number	:	810-694-4580
Fax Number	:	810-694-4580

Provider Business Practice Location Address
First Line	:	1814 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-3532
Country	:	US
Telephone Number	:	248-608-2626
Fax Number	:	248-608-8149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	12/23/2009

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