Individual
DR. BROOKE MARIE-OSGOOD FUKUOKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
826 EASTLAND DR, TWIN FALLS, ID 83301-6858
(208) 732-7447
Mailing address
1508 N LYNDON ST, JEROME, ID 83338-5026
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-4533
ID
Other
Enumeration date
04/20/2012
Last updated
03/17/2021
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