Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 6320 | NC |
NPI | 1053538330 |
---|---|
Provider Name | Richard Brooks |
First Address | Cary, NC 27513-8445 |
Second Address | Cary, NC 27513-8445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
899001W | (05) | NC |