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Organization
BROOKS DENTAL ASSOCIATES
Active
Organization
BROOKS DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES P BROOKS SR. DDS (OWNER)
(229) 723-4111
Entity
Organization
Contact information
Practice address
13762 MAGNOLIA ST, BLAKELY, GA 39823-1875
(229) 723-4111
(229) 723-6083
Mailing address
PO BOX 707, BLAKELY, GA 39823-0707
(229) 723-4111
(229) 723-6083
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN007286
GA
122300000X
Dentist
DN014123
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00044789C
—
GA
05
—
203717975A
—
GA
Enumeration date
05/19/2011
Last updated
05/19/2011
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