Provider Demographics
NPI:1699801480
Name:BROOKS, JOSHUA DANIEL (DPD)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:DANIEL
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7233 W DESCHUTES AVE.
Mailing Address - Street 2:SUITE E
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-586-4350
Mailing Address - Fax:888-656-9322
Practice Address - Street 1:7233 W DESCHUTES AVE.
Practice Address - Street 2:SUITE E
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-586-4350
Practice Address - Fax:888-656-9322
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DN00000391122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5047626Medicaid