Provider Demographics
NPI:1609612076
Name:EISSENS, BREIYCE LYN
Entity type:Individual
Prefix:
First Name:BREIYCE
Middle Name:LYN
Last Name:EISSENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44230 S CLODFELTER RD
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-7644
Mailing Address - Country:US
Mailing Address - Phone:509-378-9864
Mailing Address - Fax:
Practice Address - Street 1:2469 QUEENSGATE DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9120
Practice Address - Country:US
Practice Address - Phone:509-628-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist