Healthcare Provider Details

I. General information

NPI: 1174674592
Provider Name (Legal Business Name): BROOKS CURTIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 MAIN ST
GORHAM ME
04038-1338
US

IV. Provider business mailing address

347 MAIN ST
GORHAM ME
04038-1338
US

V. Phone/Fax

Practice location:
  • Phone: 207-839-3006
  • Fax:
Mailing address:
  • Phone: 207-839-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2221
License Number StateME

VIII. Authorized Official

Name: DR. RONALD C BROOKS
Title or Position: PARTNER
Credential: DDS
Phone: 207-839-3006