Provider Demographics
NPI:1649431859
Name:BROOKSHIRE, FRIEDA V (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:FRIEDA
Middle Name:V
Last Name:BROOKSHIRE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12791 NEWPORT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2785
Mailing Address - Country:US
Mailing Address - Phone:714-838-3400
Mailing Address - Fax:714-544-0465
Practice Address - Street 1:12791 NEWPORT AVE STE 100
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2785
Practice Address - Country:US
Practice Address - Phone:714-838-3400
Practice Address - Fax:714-544-0465
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43904122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics