Provider Demographics
NPI:1710219118
Name:BROOKS, LASHANDIA RENAE ((DDS))
Entity Type:Individual
Prefix:DR
First Name:LASHANDIA
Middle Name:RENAE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:(DDS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 FAIRBURN RD SW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5256
Mailing Address - Country:US
Mailing Address - Phone:404-349-7777
Mailing Address - Fax:404-349-8459
Practice Address - Street 1:2440 FAIRBURN RD SW
Practice Address - Street 2:SUITE 301
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5256
Practice Address - Country:US
Practice Address - Phone:404-349-7777
Practice Address - Fax:404-349-8459
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0139781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA134434378EMedicaid