Joseph W Brookreson
Individual provider Active NPI Dentist · Martinsburg, WV
NPI 1376653428 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1376653428
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2434 (WV)
- Practice address
- 1003 Sushruta Dr
Martinsburg, WV 25401 - Phone
- (304) 263-3367
- Fax
- (304) 263-1634
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jay S Boyd DDS PLLC | Past | Accepting new patients | |
| DRS Bonifant & Brookreson DDS PLLC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2434 | WV | Yes |
Addresses
Primary practice location
1003 Sushruta Dr
Martinsburg, WV 25401
Mailing address
396 Thatcher Rd
Martinsburg, WV 25403
Phone (304) 263-2823
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 138410 | Other | WV | UNITED CONCORDIA |
| 0136323000 | Medicaid | WV | |
| 140435 | Other | VA | ANTHEM BCBS |
Other providers in Martinsburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.