Brooks Dental Associates
Organization Active NPI Dentist · Blakely, GA
NPI 1023301348 · NPPES record last updated May 19, 2011
Key facts
- NPI
- 1023301348
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- License
- DN007286 (GA)
- Legal business name
- BROOKS DENTAL ASSOCIATES
- Practice address
- 13762 Magnolia St
Blakely, GA 39823-1875 - Phone
- (229) 723-4111
- Fax
- (229) 723-6083
- NPI assigned
- May 19, 2011
- Organization subpart
- No
Authorized official
- Name
- Dr. Charles P Brooks Sr., DDS
- Title
- Owner
- Phone
- (229) 723-4111
Practitioners 1
-
Charles Paschal Brooks Jr., D.M.D.
National Provider Directory
Locations
13762 Magnolia St
Blakely, GA 39823
Phone (229) 723-4111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | DN007286 | GA | Yes |
| Dentist |
122300000X | DN014123 | GA |
Addresses
Primary practice location
13762 Magnolia St
Blakely, GA 39823-1875
Mailing address
PO Box 707
Blakely, GA 39823-0707
Phone (229) 723-4111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 203717975A | Medicaid | GA | |
| 00044789C | Medicaid | GA |
Other providers in Blakely, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.