Provider Demographics
NPI:1316507379
Name:BRIGGS, SHAWN LOGAN (DMD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:LOGAN
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 SE HARROLD TER
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6913
Mailing Address - Country:US
Mailing Address - Phone:337-308-5550
Mailing Address - Fax:
Practice Address - Street 1:451 UNIVERSITY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3102
Practice Address - Country:US
Practice Address - Phone:561-258-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist