Provider Demographics
NPI:1992074249
Name:BRIEN FAMILY DENTRISTRY
Entity type:Organization
Organization Name:BRIEN FAMILY DENTRISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-928-5600
Mailing Address - Street 1:7660 GOODWOOD BLVD STE A101
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7667
Mailing Address - Country:US
Mailing Address - Phone:225-928-5600
Mailing Address - Fax:225-928-3925
Practice Address - Street 1:7660 GOODWOOD BLVD STE A101
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7667
Practice Address - Country:US
Practice Address - Phone:225-928-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5998122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty