Provider Demographics
NPI:1982225223
Name:BROOKS, STEPHANIE MCCARTHY (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MCCARTHY
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:ANNE
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:63 RUTLAND ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1586
Mailing Address - Country:US
Mailing Address - Phone:508-308-9529
Mailing Address - Fax:
Practice Address - Street 1:63 RUTLAND ST APT 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-1586
Practice Address - Country:US
Practice Address - Phone:508-308-9529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN18586371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program