Organization
DRBROOKSBY.COM,INC
Active
Other names
Sequim Advanced Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYLE SCOTT BROOKSBY DDS (PRESIDENT)
(702) 274-6700
Entity
Organization
Contact information
Practice address
680 W WASHINGTON ST STE E102, SEQUIM, WA 98382-3264
(702) 274-6700
Mailing address
2022 TAYLOR CUTOFF RD, SEQUIM, WA 98382-8294
(702) 274-6700
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60450842
DENTAL LICENSE NUMBER
WA
Enumeration date
08/21/2019
Last updated
08/21/2019
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