Provider Demographics
NPI:1063533354
Name:BRISCOE, PATRICK (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:BRISCOE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 H G MOSLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2948
Mailing Address - Country:US
Mailing Address - Phone:903-753-2151
Mailing Address - Fax:903-753-0884
Practice Address - Street 1:3006 H G MOSLEY PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2948
Practice Address - Country:US
Practice Address - Phone:903-753-2151
Practice Address - Fax:903-753-0884
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1114234556OtherULTRA ORTHODONTICS
TX1427168541OtherSHERMAN & BRISCOE ORTHODONTICS