MEDICARE: DR. ALEXIS GABRIELLE BROOKE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN25835	FL

General Provider Information

NPI Number	:	1437727864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS GABRIELLE BROOKE DMD

Provider Business Mailing Address
First Line	:	8810 HINSDALE HEIGHTS DR
Second Line	:
City	:	POLK CITY
State	:	FL
Zip	:	33868-6012
Country	:	US
Telephone Number	:	863-602-0364
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 US HIGHWAY 98 N UNIT 105
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-3863
Country	:	US
Telephone Number	:	863-225-4585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2021
Last Update Date	:	08/01/2022

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