MEDICARE: BROOKE NAQUIN

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	1223G0001X	General Practice Dentistry	7655	LA

General Provider Information

NPI Number	:	1912896127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE NAQUIN

Provider Business Mailing Address
First Line	:	904 DAVID DR
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	904 DAVID DR
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1316
Country	:	US
Telephone Number	:	985-384-4044
Fax Number	:

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

Provider Enumeration Date	:	07/01/2025
Last Update Date	:	07/01/2025

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Directions to “ BROOKE NAQUIN ” Practice Location

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