Provider Demographics
NPI:1831275551
Name:BROOKS, MARK L (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1616 CORNWALL AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4642
Mailing Address - Country:US
Mailing Address - Phone:360-676-6177
Mailing Address - Fax:360-671-3574
Practice Address - Street 1:6060 PORTAL WAY
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-7833
Practice Address - Country:US
Practice Address - Phone:360-676-6177
Practice Address - Fax:360-671-3574
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WADE000076471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0174704OtherLABOR AND INDUSTRIES
WA5024534Medicaid
WA5877BROtherREGENCE BLUE SHIELD