Provider Demographics
NPI:1508910019
Name:BROOKSHER, STEVEN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:H
Last Name:BROOKSHER
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 1:1010 S ACADIAN THRUWAY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6949
Mailing Address - Country:US
Mailing Address - Phone:225-346-8625
Mailing Address - Fax:225-387-4329
Practice Address - Street 1:1010 S ACADIAN THRUWAY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6949
Practice Address - Country:US
Practice Address - Phone:225-346-8625
Practice Address - Fax:225-387-4329
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA31161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3116OtherSTATE LICENSE NUMBER