MEDICARE: ROBERT THIBEAULT BROOKINGS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DEN4807	ME

General Provider Information

NPI Number	:	1124644950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT THIBEAULT BROOKINGS

Provider Business Mailing Address
First Line	:	39 GROVE ST
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04401-5309
Country	:	US
Telephone Number	:	207-944-9980
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 GROVE STREET
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04401-5309
Country	:	US
Telephone Number	:	207-947-6239
Fax Number	:	207-947-4703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	06/17/2020

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Directions to “ ROBERT THIBEAULT BROOKINGS ” Practice Location

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