MEDICARE: JAN BROOKS BSDH, RDH, RDHAP

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	124Q00000X	Dental Hygienist	21351	CA
2	124Q00000X	Dental Hygienist	657	CA

General Provider Information

NPI Number	:	1700262771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN BROOKS BSDH, RDH, RDHAP

Provider Business Mailing Address
First Line	:	4959 SEVEN HILLS RD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-2434
Country	:	US
Telephone Number	:	510-364-1756
Fax Number	:

Provider Business Practice Location Address
First Line	:	4959 SEVEN HILLS RD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-2434
Country	:	US
Telephone Number	:	510-364-1756
Fax Number	:

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

Provider Enumeration Date	:	07/31/2015
Last Update Date	:	09/03/2024

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