Organization
BROOKINGS DENTAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY RAY HARBOLT DMD (MANAGING DENTIST)
(541) 469-5371
Entity
Organization
Contact information
Practice address
565 5TH ST, 2, BROOKINGS, OR 97415-9724
(541) 469-5371
Mailing address
565 5TH ST, SUITE #2, BROOKINGS, OR 97415-9724
(541) 469-5371
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D6816
OR
Other
Enumeration date
04/11/2017
Last updated
04/11/2017
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