Healthcare Provider Details

I. General information

NPI: 1285854869
Provider Name (Legal Business Name): ROBERT L. BROOKINGS, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 GROVE ST
BANGOR ME
04401-5309
US

IV. Provider business mailing address

39 GROVE ST
BANGOR ME
04401-5309
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-6239
  • Fax:
Mailing address:
  • Phone: 207-947-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3255
License Number StateME

VIII. Authorized Official

Name: DR. ROBERT L BROOKINGS
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 207-947-6239