Healthcare Provider Details

I. General information

NPI: 1760365704
Provider Name (Legal Business Name): BRIAN BRIESEMEISTER DDS AND ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 W MOREHEAD ST STE 103
CHARLOTTE NC
28208-5185
US

IV. Provider business mailing address

1301 BRIDGEPORT WAY STE 109
SUFFOLK VA
23435-1960
US

V. Phone/Fax

Practice location:
  • Phone: 757-929-7100
  • Fax:
Mailing address:
  • Phone: 757-929-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: BRIAN GENE BRIESEMEISTER
Title or Position: OWNER
Credential: DDS
Phone: 757-929-7100