Healthcare Provider Details

I. General information

NPI: 1841645900
Provider Name (Legal Business Name): BROOKS & BROOKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 MEADE AVE
PROSSER WA
99350-1423
US

IV. Provider business mailing address

1715 W KENNEWICK AVE
KENNEWICK WA
99336-3378
US

V. Phone/Fax

Practice location:
  • Phone: 509-786-2963
  • Fax:
Mailing address:
  • Phone: 509-786-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN00000391
License Number StateWA

VIII. Authorized Official

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