MEDICARE: MRS. ELIZABETH NICOLE BRICENO DMD

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	122300000X	Dentist	DN18454	FL
2	122300000X	Dentist	22239	MA
3	122300000X	Dentist	27884	TX

General Provider Information

NPI Number	:	1558523373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH NICOLE BRICENO DMD

Provider Business Mailing Address
First Line	:	7844 LONG POINT RD.
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-3621
Country	:	US
Telephone Number	:	713-956-8767
Fax Number	:	713-956-1952

Provider Business Practice Location Address
First Line	:	7844 LONG POINT RD.
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-3621
Country	:	US
Telephone Number	:	713-956-8767
Fax Number	:	713-956-1952

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

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	07/13/2012

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