Provider Demographics
NPI:1679735740
Name:BRIGGS, STORM (DDS)
Entity type:Individual
Prefix:DR
First Name:STORM
Middle Name:
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6513 14TH ST W
Mailing Address - Street 2:SUITE 131
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-5865
Mailing Address - Country:US
Mailing Address - Phone:941-758-8900
Mailing Address - Fax:
Practice Address - Street 1:6513 14TH ST W
Practice Address - Street 2:SUITE 131
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-5865
Practice Address - Country:US
Practice Address - Phone:941-758-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 182221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice