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General NPI Number Information
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NPI Number | 1366794018
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Entity Type | Individual
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Provider Name | BENITA K BROOKS DDS
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Gender | Female
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 02/22/2019
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Provider Practice Location Address
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Address Line | 620 HUMBOLDT ST
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City | RENO
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State | NV
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Zip | 89509
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Country | US
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Telephone | 916-833-8245
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Fax |
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Provider Business Mailing Address
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Address Line | 3277 SUSILEEN DR
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City | RENO
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State | NV
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Zip | 89509-3859
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Country | US
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Telephone | 916-833-8245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6326
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License Number State | NV
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