# DR. MARK L BROOKS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1831275551
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE00007647 | WA | Yes |

## Other

- **Enumeration date:** 10/27/2006
- **Last updated:** 05/21/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0174704 | LABOR AND INDUSTRIES | WA |
| 05 | — | 5024534 | — | WA |
| 01 | — | 5877BR | REGENCE BLUE SHIELD | WA |