Healthcare Provider Details

I. General information

NPI: 1154743813
Provider Name (Legal Business Name): JOSHUA D BROOKS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7233 W DESCHUTES AVE. SUITE E
KENNEWICK WA
99336
US

IV. Provider business mailing address

7233 W DESCHUTES AVE. SUITE E
KENNEWICK WA
99336
US

V. Phone/Fax

Practice location:
  • Phone: 509-586-4350
  • Fax: 888-656-9322
Mailing address:
  • Phone: 509-586-4350
  • Fax: 888-656-9322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDB00000391
License Number StateWA

VIII. Authorized Official

Name: JOSHUA DANIEL BROOKS
Title or Position: SOLE MEMBER
Credential:
Phone: 509-586-4350