Provider Demographics
NPI:1437727864
Name:BROOKE, ALEXIS GABRIELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:GABRIELLE
Last Name:BROOKE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 HINSDALE HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33868-6012
Mailing Address - Country:US
Mailing Address - Phone:863-602-0364
Mailing Address - Fax:
Practice Address - Street 1:3700 US HIGHWAY 98 N UNIT 105
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3863
Practice Address - Country:US
Practice Address - Phone:863-225-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-13
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist