# DR MITCHELL BROOKSTONE DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548434095
- **Authorized official:** DR. MITCHELL S BROOKSTONE DDS (PRESIDENT OWNER)
- **Authorized official phone:** (516) 826-1666

## Contact information

- **Practice address:** 1228 WANTAGH AVENUE, SUITE 101, WANTAGH, NY 11793
- **Practice address phone:** (516) 826-1666
- **Practice address fax:** (516) 783-7716
- **Mailing address:** 1228 WANTAGH AVENUE, SUITE 101, WANTAGH, NY 11793
- **Mailing address phone:** (516) 826-1666
- **Mailing address fax:** (516) 783-7716

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 042202 | NY | Yes |

## Other

- **Enumeration date:** 04/16/2008
- **Last updated:** 04/16/2008