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General NPI Number Information
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NPI Number | 1689408270
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Entity Type | Individual
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Provider Name | STACIA ANNE BROOKS RDH
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Gender | Female
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Dates
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Enumeration Date | 08/27/2024
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 8066 BOWIE RD
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City | KING GEORGE
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State | VA
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Zip | 22485-7665
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Country | US
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Telephone | 703-401-1755
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Fax |
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Provider Business Mailing Address
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Address Line | 8066 BOWIE RD
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City | KING GEORGE
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State | VA
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Zip | 22485-7665
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Country | US
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Telephone | 703-401-1755
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 0402205910
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 6766
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License Number State | MD
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