Provider Demographics
NPI:1497449854
Name:LAFFOON, BROOKS ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BROOKS
Middle Name:ANN
Last Name:LAFFOON
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 1:3042 LEDGEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6528
Mailing Address - Country:US
Mailing Address - Phone:479-567-6044
Mailing Address - Fax:
Practice Address - Street 1:301 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1243
Practice Address - Country:US
Practice Address - Phone:502-584-1322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist