Provider Demographics
NPI:1083854236
Name:BROOKHAVEN FAMILY DENTISTRY, P. C.
Entity Type:Organization
Organization Name:BROOKHAVEN FAMILY DENTISTRY, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKABI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-921-9059
Mailing Address - Street 1:3528 ASHFORD DUNWOODY RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2002
Mailing Address - Country:US
Mailing Address - Phone:770-451-0611
Mailing Address - Fax:
Practice Address - Street 1:3528 ASHFORD DUNWOODY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-2002
Practice Address - Country:US
Practice Address - Phone:770-451-0611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-01
Last Update Date:2009-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental