Provider Demographics
NPI:1295928752
Name:JOSH BROOKS, PLLC
Entity type:Organization
Organization Name:JOSH BROOKS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-586-4350
Mailing Address - Street 1:7233 W DESCHUTES AVE.
Mailing Address - Street 2:SUITE E
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-586-4350
Mailing Address - Fax:888-656-9322
Practice Address - Street 1:7233 W DESCHUTES AVE.
Practice Address - Street 2:SUITE E
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-586-4350
Practice Address - Fax:888-656-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-19
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X, 1223G0001X, 124Q00000X, 126800000X, 126900000X
WADN00000391122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No126800000XDental ProvidersDental AssistantGroup - Single Specialty
No126900000XDental ProvidersDental Laboratory TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5047626Medicaid