Provider Demographics
NPI:1184051591
Name:CURTIS A BROOKOVER, DDS, PC
Entity type:Organization
Organization Name:CURTIS A BROOKOVER, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-662-4503
Mailing Address - Street 1:3491 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2398
Mailing Address - Country:US
Mailing Address - Phone:505-662-4503
Mailing Address - Fax:
Practice Address - Street 1:3491 TRINITY DR
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2398
Practice Address - Country:US
Practice Address - Phone:505-662-4503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD19561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM122300000XOtherDENTIST