Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DE00011225 | WA |
NPI | 1083691273 |
---|---|
Provider Name | Dr. Michael D Brooks |
First Address | Poulsbo, WA 98370-7441 |
Second Address | Poulsbo, WA 98370-7441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 16/06/2008 |