Provider Demographics
NPI:1952406423
Name:BROOKS, BRENT WILLIAM (DDS MS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:WILLIAM
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:2210 KULSHAM VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273
Mailing Address - Country:US
Mailing Address - Phone:360-428-4979
Mailing Address - Fax:360-848-5994
Practice Address - Street 1:2210 KULSHAM VIEW DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273
Practice Address - Country:US
Practice Address - Phone:360-428-4979
Practice Address - Fax:360-848-5994
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WADE000088341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics