Provider Demographics
NPI:1669268090
Name:BROOKS DENTAL LLC
Entity type:Organization
Organization Name:BROOKS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-560-6960
Mailing Address - Street 1:68-1874 LINA POEPOE ST
Mailing Address - Street 2:
Mailing Address - City:WAIKOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96738-5421
Mailing Address - Country:US
Mailing Address - Phone:480-560-6960
Mailing Address - Fax:
Practice Address - Street 1:65-1279 KAWAIHAE RD STE 101
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8444
Practice Address - Country:US
Practice Address - Phone:808-885-8617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty