Provider Demographics
NPI:1962103028
Name:NAQUIN, BROOKE ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ELIZABETH
Last Name:NAQUIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12519 AIRLINE HWY STE G
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-2502
Mailing Address - Country:US
Mailing Address - Phone:985-764-7792
Mailing Address - Fax:
Practice Address - Street 1:12519 AIRLINE HWY STE G
Practice Address - Street 2:
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-2502
Practice Address - Country:US
Practice Address - Phone:985-764-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA74381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program