Provider Demographics
NPI:1215604988
Name:JOHNKE, BROOKLYNN KAYE (DT,RDH)
Entity type:Individual
Prefix:
First Name:BROOKLYNN
Middle Name:KAYE
Last Name:JOHNKE
Suffix:
Gender:F
Credentials:DT,RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-5364
Mailing Address - Country:US
Mailing Address - Phone:207-861-5801
Mailing Address - Fax:
Practice Address - Street 1:2 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-5364
Practice Address - Country:US
Practice Address - Phone:207-861-5801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH4471124Q00000X, 125J00000X
MNH11055124Q00000X
MNDT142125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist
No124Q00000XDental ProvidersDental Hygienist