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NPI Code Detail

MEDICARE: DR. MARK L BROOKS DDS

MEDICARE: DR. MARK L BROOKS DDS
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
11223G0001XGeneral Practice DentistryDE00007647WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10174704OTHERWALABOR AND INDUSTRIES
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
35877BROTHERWAREGENCE BLUE SHIELD

General Provider Information

NPI Number : 1831275551
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK L BROOKS DDS
Provider Business Mailing Address
First Line : 1616 CORNWALL AVE STE 205
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-4642
Country : US
Telephone Number : 360-676-6177
Fax Number : 360-671-3574
Provider Business Practice Location Address
First Line : 6060 PORTAL WAY
Second Line :
City : FERNDALE
State : WA
Zip : 98248-7833
Country : US
Telephone Number : 360-676-6177
Fax Number : 360-671-3574
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 05/21/2020

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Directions to “ DR. MARK L BROOKS DDS” Practice Location

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