Provider Demographics
NPI:1366619819
Name:HENAGE, BROOKE ANNE (DMD)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ANNE
Last Name:HENAGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:BROOKE
Other - Middle Name:ANNE
Other - Last Name:HENAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41022-0395
Mailing Address - Country:US
Mailing Address - Phone:859-525-1420
Mailing Address - Fax:859-525-0948
Practice Address - Street 1:7208 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2125
Practice Address - Country:US
Practice Address - Phone:859-525-1420
Practice Address - Fax:859-525-0948
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY81461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice