Stephanie Brooks
Individual provider Active NPI Dentist · Winthrop, MA
NPI 1962992701 · NPPES record last updated Jul 14, 2018
Key facts
- NPI
- 1962992701
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN1857955 (MA)
- Practice address
- 54 Woodside Ave
Winthrop, MA 02152 - Phone
- (617) 846-1811
- Fax
- (617) 846-6087
- NPI assigned
- May 17, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1857955 | MA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brooks Dental, P.C. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | DN1857955 | MA | Yes |
Addresses
Primary practice location
54 Woodside Ave
Winthrop, MA 02152
Mailing address
529 Beacon St Apt 9
Boston, MA 02215-2331
Phone (781) 710-0309
Other providers in Winthrop, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2018. 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.