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NPI Code Detail

MEDICARE: DR. CRYSTAL ANN BROOKS DDS

MEDICARE: DR. CRYSTAL ANN BROOKS DDS
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
1122300000XDentistWI2596WI

General Provider Information

NPI Number : 1194894139
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CRYSTAL ANN BROOKS DDS
Provider Business Mailing Address
First Line : 1032 S SPRING ST
Second Line :
City : PORT WASHINGTON
State : WI
Zip : 53074-2455
Country : US
Telephone Number : 262-284-5788
Fax Number : 262-268-8284
Provider Business Practice Location Address
First Line : 1032 S SPRING ST
Second Line :
City : PORT WASHINGTON
State : WI
Zip : 53074-2455
Country : US
Telephone Number : 262-284-5788
Fax Number : 262-268-8284
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 07/08/2007

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Directions to “ DR. CRYSTAL ANN BROOKS DDS” Practice Location

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