Provider Demographics
NPI:1215151618
Name:PRISBREY, LORRAINE (DDS)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:PRISBREY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:REDWAY
Mailing Address - State:CA
Mailing Address - Zip Code:95560-0769
Mailing Address - Country:US
Mailing Address - Phone:707-923-2783
Mailing Address - Fax:707-923-2543
Practice Address - Street 1:101 WEST COAST RD.
Practice Address - Street 2:
Practice Address - City:REDWAY
Practice Address - State:CA
Practice Address - Zip Code:95560-0769
Practice Address - Country:US
Practice Address - Phone:707-923-4313
Practice Address - Fax:707-923-2590
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13177122300000X
AK1568122300000X
CA557331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55733Medicaid
AKDD7741Medicaid