Healthcare Provider Details

I. General information

NPI: 1093647190
Provider Name (Legal Business Name): BROOKLYN D THOMAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9670 E WASHINGTON ST STE 220
INDIANAPOLIS IN
46229-3051
US

IV. Provider business mailing address

9670 E WASHINGTON ST STE 220
INDIANAPOLIS IN
46229-3051
US

V. Phone/Fax

Practice location:
  • Phone: 317-897-1147
  • Fax:
Mailing address:
  • Phone: 317-897-1147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12015001A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: