Provider Demographics
NPI:1639184120
Name:UNIAT, BROOKS JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:BROOKS
Middle Name:JOSEPH
Last Name:UNIAT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 S KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4829
Mailing Address - Country:US
Mailing Address - Phone:208-459-0113
Mailing Address - Fax:208-459-7831
Practice Address - Street 1:1913 S KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4829
Practice Address - Country:US
Practice Address - Phone:208-459-0113
Practice Address - Fax:208-459-7831
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD36661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice