Provider Demographics
NPI:1497813265
Name:BROOKS, JAMIE L (DDS)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:KINOSHITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:732 BROADWAY STE 101
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3702
Mailing Address - Country:US
Mailing Address - Phone:253-777-0600
Mailing Address - Fax:253-295-5452
Practice Address - Street 1:732 BROADWAY STE 101
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3702
Practice Address - Country:US
Practice Address - Phone:253-777-0600
Practice Address - Fax:253-295-5452
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA85161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice