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Individual

DR. DETRA KASHON BROOKS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.D.S.

Contact information

Practice address
2225 E WT HARRIS BLVD, SUITE 100, CHARLOTTE, NC 28213-5138
(704) 494-4050
Mailing address
2225 E WT HARRIS BLVD, SUITE 100, CHARLOTTE, NC 28213-5138
(704) 494-4050

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6545
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
899006N
NC
Enumeration date
07/17/2008
Last updated
07/17/2008
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