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General NPI Number Information
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NPI Number | 1285948646
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Entity Type | Organization
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Legal Business Name | BRIEL D LOISEAU DDS, PS
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 05/19/2012
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Provider Practice Location Address
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Address Line | 836 SHARON AVE E
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City | MOSES LAKE
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State | WA
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Zip | 98837-2442
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Country | US
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Telephone | 509-765-1748
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Fax |
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Provider Business Mailing Address
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Address Line | 836 SHARON AVE E
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City | MOSES LAKE
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State | WA
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Zip | 98837-2442
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Country | US
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Telephone | 509-765-1748
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIEL D LOISEAU
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Credential | DDS
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Telephone | 509-765-1748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE60099971
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License Number State | WA
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