Provider Demographics
NPI:1477964476
Name:ROOK, BRANDON WESLEY (DDS)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:WESLEY
Last Name:ROOK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-0458
Mailing Address - Country:US
Mailing Address - Phone:641-684-6896
Mailing Address - Fax:641-226-5759
Practice Address - Street 1:1015 N 18TH ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1170
Practice Address - Country:US
Practice Address - Phone:641-684-6896
Practice Address - Fax:641-226-5759
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9513122300000X
IA09361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100320080Medicaid