Organization
APPLEGATE VALLEY DENTAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS GLENN BROOKS DMD (PART OWNER)
(541) 855-7920
Entity
Organization
Contact information
Practice address
181 UPPER APPLEGATE RD, SUITE 20, JACKSONVILLE, OR 97530-9739
(541) 899-7824
(541) 899-7949
Mailing address
181 UPPER APPLEGATE RD, SUITE 20, JACKSONVILLE, OR 97530-9739
(541) 899-7824
(541) 899-7949
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6262
OR
Other
Enumeration date
07/31/2015
Last updated
07/31/2015
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