MEDICARE: DR. FITZ JUNIOR BROOKS 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	DN22598	FL
2	1223P0221X	Pediatric Dentistry	DN22598	FL

General Provider Information

NPI Number	:	1992229744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FITZ JUNIOR BROOKS DMD

Provider Business Mailing Address
First Line	:	557 NE 81ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-4519
Country	:	US
Telephone Number	:	407-860-2795
Fax Number	:

Provider Business Practice Location Address
First Line	:	557 NE 81ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-4519
Country	:	US
Telephone Number	:	215-805-4867
Fax Number	:

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

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	12/15/2024

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