Provider Demographics
NPI:1124644950
Name:BROOKINGS, ROBERT THIBEAULT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:THIBEAULT
Last Name:BROOKINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5309
Mailing Address - Country:US
Mailing Address - Phone:207-944-9980
Mailing Address - Fax:
Practice Address - Street 1:39 GROVE STREET
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5309
Practice Address - Country:US
Practice Address - Phone:207-947-6239
Practice Address - Fax:207-947-4703
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN48071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice