Healthcare Provider Details

I. General information

NPI: 1437727864
Provider Name (Legal Business Name): ALEXIS GABRIELLE BROOKE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2021
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 US HIGHWAY 98 N UNIT 105
LAKELAND FL
33809-3863
US

IV. Provider business mailing address

8810 HINSDALE HEIGHTS DR
POLK CITY FL
33868-6012
US

V. Phone/Fax

Practice location:
  • Phone: 863-225-4585
  • Fax:
Mailing address:
  • Phone: 863-602-0364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN25835
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: