Individual
DR. THOMAS GLENN BROOKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
492 SECOND AVE, GOLD HILL, OR 97525-0198
(541) 855-7920
(541) 855-2511
Mailing address
PO BOX 198, GOLD HILL, OR 97525-0198
(541) 855-7920
(541) 855-2511
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6262
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D6262
DENTAL LICENSE
OR
Enumeration date
03/02/2007
Last updated
07/08/2007
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