Provider Demographics
NPI:1285948646
Name:BRIEL D LOISEAU DDS, PS
Entity type:Organization
Organization Name:BRIEL D LOISEAU DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOISEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-765-1748
Mailing Address - Street 1:836 SHARON AVE E
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2442
Mailing Address - Country:US
Mailing Address - Phone:509-765-1748
Mailing Address - Fax:
Practice Address - Street 1:836 SHARON AVE E
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2442
Practice Address - Country:US
Practice Address - Phone:509-765-1748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60099971261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental