Provider Demographics
NPI:1003560137
Name:VINTURELLA, BROOKE VIRGINIA (DDS)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:VIRGINIA
Last Name:VINTURELLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:35 RIVERBIRCH CT
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-1985
Mailing Address - Country:US
Mailing Address - Phone:985-288-7572
Mailing Address - Fax:
Practice Address - Street 1:189 GREENBRIER BLVD STE A
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7297
Practice Address - Country:US
Practice Address - Phone:985-892-5942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA73371223P0221X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223P0221XDental ProvidersDentistPediatric Dentistry