Provider Demographics
NPI:1730308842
Name:BROOKS, K. GLENN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:K.
Middle Name:GLENN
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2985 LANGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7335
Mailing Address - Country:US
Mailing Address - Phone:850-484-8090
Mailing Address - Fax:850-484-8074
Practice Address - Street 1:2985 LANGLEY AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7335
Practice Address - Country:US
Practice Address - Phone:850-484-8090
Practice Address - Fax:850-484-8074
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN135471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics