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General NPI Number Information
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NPI Number | 1821719659
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Entity Type | Individual
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Provider Name | BROOKE BRANNON POLYAKOV D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 140 STONY POINT RD STE A
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City | SANTA ROSA
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State | CA
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Zip | 95401-4121
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Country | US
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Telephone | 707-408-7838
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Fax |
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Provider Business Mailing Address
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Address Line | 140 STONY POINT RD STE A
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City | SANTA ROSA
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State | CA
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Zip | 95401-4121
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Country | US
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Telephone | 213-407-5945
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 19928
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 107997
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License Number State | CA
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